1467791590 NPI number — MRS. ANNMARIE CHRISTINE THUER CRNP

Table of content: MRS. ANNMARIE CHRISTINE THUER CRNP (NPI 1467791590)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1467791590 NPI number — MRS. ANNMARIE CHRISTINE THUER CRNP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
THUER
Provider First Name:
ANNMARIE
Provider Middle Name:
CHRISTINE
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
CRNP
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
BARAN
Provider Other First Name:
ANNMARIE
Provider Other Middle Name:
CHRISTINE
Provider Other Name Prefix Text:
MISS
Provider Other Name Suffix Text:
Provider Other Credential Text:
CRNP
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1467791590
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
01/26/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
53 OLD FORGE XING
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
DEVON
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
19333-1119
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
610-360-6471
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
100 E LANCASTER AVE
Provider Second Line Business Practice Location Address:
SUITE 370 MEDICAL SCIENCE BLDG.
Provider Business Practice Location Address City Name:
WYNNEWOOD
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
19096-3450
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
610-642-3005
Provider Business Practice Location Address Fax Number:
610-642-3057
Provider Enumeration Date:
02/09/2013

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: 363LA2100X , with the licence number:  SP012479 , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 232359401 . This is a "MAIN LINE HEALTHCARE TAX ID" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".




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