Provider Demographics
NPI:1326324435
Name:THORNSBERRY, JOHANNA ELAINE (NP)
Entity Type:Individual
Prefix:
First Name:JOHANNA
Middle Name:ELAINE
Last Name:THORNSBERRY
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 1:5325 ELLIOTT DR
Mailing Address - Street 2:MICHIGAN HEART & VASCULAR INSTITUTE, SUITE #102
Mailing Address - City:YPSILANTI
Mailing Address - State:MI
Mailing Address - Zip Code:48197-8633
Mailing Address - Country:US
Mailing Address - Phone:734-712-5500
Mailing Address - Fax:764-712-8209
Practice Address - Street 1:5325 ELLIOTT DR
Practice Address - Street 2:MICHIGAN HEART & VASCULAR INSTITUTE, SUITE #102
Practice Address - City:YPSILANTI
Practice Address - State:MI
Practice Address - Zip Code:48197
Practice Address - Country:US
Practice Address - Phone:734-712-5500
Practice Address - Fax:764-712-8209
Is Sole Proprietor?:No
Enumeration Date:2011-11-02
Last Update Date:2018-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704226160363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care