Provider Demographics
NPI:1154667913
Name:THORNTON, CRYSTAL MARIE (NP)
Entity Type:Individual
Prefix:
First Name:CRYSTAL
Middle Name:MARIE
Last Name:THORNTON
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 1:11432 BUSINESS BLVD
Mailing Address - Street 2:STE 4
Mailing Address - City:EAGLE RIVER
Mailing Address - State:AK
Mailing Address - Zip Code:99577-7720
Mailing Address - Country:US
Mailing Address - Phone:907-694-1300
Mailing Address - Fax:907-694-1315
Practice Address - Street 1:11432 BUSINESS BLVD
Practice Address - Street 2:STE 4
Practice Address - City:EAGLE RIVER
Practice Address - State:AK
Practice Address - Zip Code:99577-7720
Practice Address - Country:US
Practice Address - Phone:907-694-1300
Practice Address - Fax:907-694-1315
Is Sole Proprietor?:No
Enumeration Date:2012-12-26
Last Update Date:2012-12-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK34375163W00000X
AK373363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No163W00000XNursing Service ProvidersRegistered Nurse