Provider Demographics
NPI:1891805289
Name:THORNBURG, DENISE R (APN)
Entity Type:Individual
Prefix:
First Name:DENISE
Middle Name:R
Last Name:THORNBURG
Suffix:
Gender:F
Credentials:APN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1848 HEYDON CT
Mailing Address - Street 2:
Mailing Address - City:HENDERSON
Mailing Address - State:NV
Mailing Address - Zip Code:89014-3868
Mailing Address - Country:US
Mailing Address - Phone:702-898-1574
Mailing Address - Fax:
Practice Address - Street 1:3196 S MARYLAND PKWY
Practice Address - Street 2:SUITE 217
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89109-2305
Practice Address - Country:US
Practice Address - Phone:702-733-4944
Practice Address - Fax:702-733-6507
Is Sole Proprietor?:No
Enumeration Date:2006-08-30
Last Update Date:2012-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVAPN00038363LN0005X, 363LN0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LN0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerNeonatal
No363LN0005XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerNeonatal, Critical Care