Provider Demographics
NPI:1457835043
Name:THORSTON, REBECCA ANN (DNP, APRN, CNP)
Entity Type:Individual
Prefix:DR
First Name:REBECCA
Middle Name:ANN
Last Name:THORSTON
Suffix:
Gender:F
Credentials:DNP, APRN, CNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15428 HUBBELL LN
Mailing Address - Street 2:
Mailing Address - City:GOOD THUNDER
Mailing Address - State:MN
Mailing Address - Zip Code:56037-2138
Mailing Address - Country:US
Mailing Address - Phone:320-583-7082
Mailing Address - Fax:
Practice Address - Street 1:200 E PRINCE ST
Practice Address - Street 2:
Practice Address - City:LAKE CRYSTAL
Practice Address - State:MN
Practice Address - Zip Code:56055-2043
Practice Address - Country:US
Practice Address - Phone:507-726-6966
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-09-19
Last Update Date:2020-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN6194363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily