1548667983 NPI number — MS. JENNIFER ANNE THOR M.A.

Table of content: MS. JENNIFER ANNE THOR M.A. (NPI 1548667983)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1548667983 NPI number — MS. JENNIFER ANNE THOR M.A.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
THOR
Provider First Name:
JENNIFER
Provider Middle Name:
ANNE
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
M.A.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1548667983
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
04/10/2019
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 274
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BUXTON
Provider Business Mailing Address State Name:
NC
Provider Business Mailing Address Postal Code:
27920-0274
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
919-280-5031
Provider Business Mailing Address Fax Number:
252-995-3340

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
41838 NC 12
Provider Second Line Business Practice Location Address:
STE 104
Provider Business Practice Location Address City Name:
AVON
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
27915
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
252-996-0706
Provider Business Practice Location Address Fax Number:
252-995-3340
Provider Enumeration Date:
12/01/2014

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 101YM0800X , with the licence number:  14375 , registered in the state of NC ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 101YM0800X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)





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