Provider Demographics
NPI:1164150769
Name:THOREN, JOSHUA BLAKE (CNM)
Entity Type:Individual
Prefix:
First Name:JOSHUA
Middle Name:BLAKE
Last Name:THOREN
Suffix:
Gender:M
Credentials:CNM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:150 N EAST RIVER RD APT 127
Mailing Address - Street 2:
Mailing Address - City:DES PLAINES
Mailing Address - State:IL
Mailing Address - Zip Code:60016-1277
Mailing Address - Country:US
Mailing Address - Phone:208-615-1848
Mailing Address - Fax:
Practice Address - Street 1:910 W 5TH AVE STE 300
Practice Address - Street 2:
Practice Address - City:SPOKANE
Practice Address - State:WA
Practice Address - Zip Code:99204-2972
Practice Address - Country:US
Practice Address - Phone:208-615-1848
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-08-11
Last Update Date:2022-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife