Provider Demographics
NPI:1699138990
Name:THORSTENSON, RACHEL (CRNA)
Entity type:Individual
Prefix:
First Name:RACHEL
Middle Name:
Last Name:THORSTENSON
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7451 GIRARD AVE
Mailing Address - Street 2:
Mailing Address - City:LA JOLLA
Mailing Address - State:CA
Mailing Address - Zip Code:92037-5143
Mailing Address - Country:US
Mailing Address - Phone:217-419-0271
Mailing Address - Fax:
Practice Address - Street 1:7451 GIRARD AVE
Practice Address - Street 2:
Practice Address - City:LA JOLLA
Practice Address - State:CA
Practice Address - Zip Code:92037-5143
Practice Address - Country:US
Practice Address - Phone:217-419-0271
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-04-04
Last Update Date:2024-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209014097367500000X
CANA95002253367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered