Provider Demographics
NPI:1104822824
Name:THORNE, JOAN (CRNA)
Entity Type:Individual
Prefix:MS
First Name:JOAN
Middle Name:
Last Name:THORNE
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 1:332 N LAUDERDALE ST
Mailing Address - Street 2:
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38105-2794
Mailing Address - Country:US
Mailing Address - Phone:901-495-3006
Mailing Address - Fax:901-495-3842
Practice Address - Street 1:332 N LAUDERDALE ST # MS 0515
Practice Address - Street 2:C/O DANA CANNON
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38105-2729
Practice Address - Country:US
Practice Address - Phone:901-495-3006
Practice Address - Fax:901-495-3842
Is Sole Proprietor?:No
Enumeration Date:2005-06-27
Last Update Date:2007-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN66483367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3602528Medicaid
LA1132586Medicaid
OR274929Medicaid
AZ794314Medicaid
MS00126471Medicaid
VA8950393Medicaid
SCQAN020Medicaid
NC8052311Medicaid
NM82736863Medicaid
NM82736863Medicaid