Provider Demographics
NPI:1598399461
Name:THORNE, ELYSE LYN (NP)
Entity Type:Individual
Prefix:
First Name:ELYSE
Middle Name:LYN
Last Name:THORNE
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:ELYSE
Other - Middle Name:LYN
Other - Last Name:GROGAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:NP
Mailing Address - Street 1:2253 N TALBOTT ST
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46205-4347
Mailing Address - Country:US
Mailing Address - Phone:317-796-2619
Mailing Address - Fax:
Practice Address - Street 1:2253 N TALBOTT ST
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46205-4347
Practice Address - Country:US
Practice Address - Phone:317-796-2619
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-02-28
Last Update Date:2024-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN71010471A363L00000X, 363LF0000X
IN28206959A163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No163W00000XNursing Service ProvidersRegistered Nurse
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN364430289OtherMEDICARE PTAN
IN300043513Medicaid