Provider Demographics
NPI:1477821072
Name:THORSLAND, MENDY (RN)
Entity Type:Individual
Prefix:
First Name:MENDY
Middle Name:
Last Name:THORSLAND
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:612 S DECATUR ST
Mailing Address - Street 2:
Mailing Address - City:WATKINS GLEN
Mailing Address - State:NY
Mailing Address - Zip Code:14891-1613
Mailing Address - Country:US
Mailing Address - Phone:607-535-3252
Mailing Address - Fax:607-535-7012
Practice Address - Street 1:612 S DECATUR ST
Practice Address - Street 2:
Practice Address - City:WATKINS GLEN
Practice Address - State:NY
Practice Address - Zip Code:14891-1613
Practice Address - Country:US
Practice Address - Phone:607-535-3252
Practice Address - Fax:607-535-7012
Is Sole Proprietor?:Yes
Enumeration Date:2011-12-09
Last Update Date:2011-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY481226-1163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse