Provider Demographics
NPI:1508644717
Name:THORLA, CASSANDRA (CPNP-PC)
Entity Type:Individual
Prefix:MISS
First Name:CASSANDRA
Middle Name:
Last Name:THORLA
Suffix:
Gender:F
Credentials:CPNP-PC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4801 ALUM SPRINGS LN APT 206
Mailing Address - Street 2:
Mailing Address - City:FREDERICKSBURG
Mailing Address - State:VA
Mailing Address - Zip Code:22407-2677
Mailing Address - Country:US
Mailing Address - Phone:561-901-4393
Mailing Address - Fax:
Practice Address - Street 1:9755 COURTHOUSE RD STE 101
Practice Address - Street 2:
Practice Address - City:SPOTSYLVANIA
Practice Address - State:VA
Practice Address - Zip Code:22553-1984
Practice Address - Country:US
Practice Address - Phone:540-898-9680
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-09-19
Last Update Date:2023-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0024188068208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Multi-Specialty