Provider Demographics
NPI:1699869420
Name:THORNE, REBECCA MARIE (NP)
Entity type:Individual
Prefix:
First Name:REBECCA
Middle Name:MARIE
Last Name:THORNE
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2505 HAPPY VALLEY RD
Mailing Address - Street 2:
Mailing Address - City:WOOSTER
Mailing Address - State:OH
Mailing Address - Zip Code:44691-8566
Mailing Address - Country:US
Mailing Address - Phone:773-573-6420
Mailing Address - Fax:
Practice Address - Street 1:1761 BEALL AVE STE 3B
Practice Address - Street 2:
Practice Address - City:WOOSTER
Practice Address - State:OH
Practice Address - Zip Code:44691-2342
Practice Address - Country:US
Practice Address - Phone:330-202-5676
Practice Address - Fax:330-202-5677
Is Sole Proprietor?:No
Enumeration Date:2006-10-03
Last Update Date:2022-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209005088363LA2200X
OH10179363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2893061Medicaid