Provider Demographics
NPI:1164614384
Name:THORNER, GRETCHEN ELIZABETH (PA-C)
Entity Type:Individual
Prefix:MRS
First Name:GRETCHEN
Middle Name:ELIZABETH
Last Name:THORNER
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:3911 CASTLEVALE RD
Mailing Address - Street 2:STE 301
Mailing Address - City:YAKIMA
Mailing Address - State:WA
Mailing Address - Zip Code:98902-7807
Mailing Address - Country:US
Mailing Address - Phone:509-966-7899
Mailing Address - Fax:
Practice Address - Street 1:506 N 40TH AVE
Practice Address - Street 2:#201
Practice Address - City:YAKIMA
Practice Address - State:WA
Practice Address - Zip Code:98908-4318
Practice Address - Country:US
Practice Address - Phone:509-966-7899
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-08-11
Last Update Date:2018-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0127041363AS0400X
WA60270956363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical