Provider Demographics
NPI:1386011716
Name:THORNBURG, SARAH ELYSE (CRNP)
Entity Type:Individual
Prefix:
First Name:SARAH
Middle Name:ELYSE
Last Name:THORNBURG
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:851 N 28TH ST # B
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19130-1227
Mailing Address - Country:US
Mailing Address - Phone:610-704-6695
Mailing Address - Fax:
Practice Address - Street 1:850 N 11TH ST
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19123-1957
Practice Address - Country:US
Practice Address - Phone:215-769-1100
Practice Address - Fax:267-597-3622
Is Sole Proprietor?:No
Enumeration Date:2015-09-02
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARN637670163W00000X
PASP015312363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No163W00000XNursing Service ProvidersRegistered Nurse