Provider Demographics
NPI:1275280836
Name:THORSON, STARLETT ANN (RN)
Entity Type:Individual
Prefix:
First Name:STARLETT
Middle Name:ANN
Last Name:THORSON
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:STARLETT
Other - Middle Name:ANN
Other - Last Name:JOHNSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:26645 JONQUIL AVE
Mailing Address - Street 2:
Mailing Address - City:ELKO NEW MARKET
Mailing Address - State:MN
Mailing Address - Zip Code:55020-9594
Mailing Address - Country:US
Mailing Address - Phone:952-240-9648
Mailing Address - Fax:
Practice Address - Street 1:26645 JONQUIL AVE
Practice Address - Street 2:
Practice Address - City:ELKO NEW MARKET
Practice Address - State:MN
Practice Address - Zip Code:55020-9594
Practice Address - Country:US
Practice Address - Phone:952-240-9648
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-03-03
Last Update Date:2022-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNR131539-6163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse