Provider Demographics
NPI:1477004588
Name:THORSNESS, MICHELLE (CNP)
Entity Type:Individual
Prefix:
First Name:MICHELLE
Middle Name:
Last Name:THORSNESS
Suffix:
Gender:F
Credentials:CNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 218
Mailing Address - Street 2:
Mailing Address - City:FOLEY
Mailing Address - State:MN
Mailing Address - Zip Code:56329-0218
Mailing Address - Country:US
Mailing Address - Phone:320-968-7234
Mailing Address - Fax:320-968-7237
Practice Address - Street 1:471 HIGHWAY 23
Practice Address - Street 2:
Practice Address - City:FOLEY
Practice Address - State:MN
Practice Address - Zip Code:56329-9145
Practice Address - Country:US
Practice Address - Phone:320-968-7234
Practice Address - Fax:320-968-7237
Is Sole Proprietor?:No
Enumeration Date:2016-10-24
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNCNP4866363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
MNMT4089997OtherDEA NUMBER
MNMT4089997OtherDEA NUMBER