Provider Demographics
NPI:1376753566
Name:THURSTON, MARYANN (IBCLC)
Entity Type:Individual
Prefix:
First Name:MARYANN
Middle Name:
Last Name:THURSTON
Suffix:
Gender:F
Credentials:IBCLC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11624 N 83RD PL
Mailing Address - Street 2:
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85260-5656
Mailing Address - Country:US
Mailing Address - Phone:480-831-9504
Mailing Address - Fax:
Practice Address - Street 1:11624 N 83RD PL
Practice Address - Street 2:
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85260-5656
Practice Address - Country:US
Practice Address - Phone:480-831-9504
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-23
Last Update Date:2013-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist