Provider Demographics
NPI:1386617926
Name:THURSTON, JAMES L (CRNA)
Entity type:Individual
Prefix:
First Name:JAMES
Middle Name:L
Last Name:THURSTON
Suffix:
Gender:M
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:440 SUNRISE PKWY
Mailing Address - Street 2:
Mailing Address - City:FARMINGTON
Mailing Address - State:NM
Mailing Address - Zip Code:87401-9255
Mailing Address - Country:US
Mailing Address - Phone:505-419-4365
Mailing Address - Fax:
Practice Address - Street 1:801 W MAPLE ST
Practice Address - Street 2:
Practice Address - City:FARMINGTON
Practice Address - State:NM
Practice Address - Zip Code:87401-5630
Practice Address - Country:US
Practice Address - Phone:505-419-4365
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-02-13
Last Update Date:2013-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMR25232367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
NMNM006486OtherBCBS
AZ750382Medicaid
CO97252324Medicaid
UTT0590Medicaid
NM201010016OtherPRESBYTERIAN HP
NMP00118798OtherRR MEDICARE
NM10002236OtherLOVELACE HP
NM91991Medicaid
NM$$$$$$$$$1Medicare PIN