Provider Demographics
NPI:1730299504
Name:THONEN, CARRIE LIANNE YUDA (APRN)
Entity Type:Individual
Prefix:MRS
First Name:CARRIE
Middle Name:LIANNE YUDA
Last Name:THONEN
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:CARRIE
Other - Middle Name:
Other - Last Name:YUDA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:APRN
Mailing Address - Street 1:PO BOX 909
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40201-0909
Mailing Address - Country:US
Mailing Address - Phone:502-588-0325
Mailing Address - Fax:
Practice Address - Street 1:1900 BLUEGRASS AVE STE 300
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40215-1183
Practice Address - Country:US
Practice Address - Phone:502-977-5907
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-30
Last Update Date:2021-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO127268363LW0102X
KY3006638363LW0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY7100142980Medicaid
CO11301830Medicaid
KY50086583OtherPASSPORT
KY000000933022OtherANTHEM
KY5395790OtherAETNA
KY5395790OtherAETNA