Provider Demographics
NPI:1023354099
Name:THORBAHN, AMY JO (RN,BSN)
Entity type:Individual
Prefix:MS
First Name:AMY
Middle Name:JO
Last Name:THORBAHN
Suffix:
Gender:F
Credentials:RN,BSN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:28 WILLIAM ST
Mailing Address - Street 2:
Mailing Address - City:GOUVERNEUR
Mailing Address - State:NY
Mailing Address - Zip Code:13642-1405
Mailing Address - Country:US
Mailing Address - Phone:315-287-2811
Mailing Address - Fax:315-287-4743
Practice Address - Street 1:28 WILLIAM ST
Practice Address - Street 2:
Practice Address - City:GOUVERNEUR
Practice Address - State:NY
Practice Address - Zip Code:13642-1405
Practice Address - Country:US
Practice Address - Phone:315-287-2811
Practice Address - Fax:315-287-4743
Is Sole Proprietor?:No
Enumeration Date:2012-12-20
Last Update Date:2012-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY490265 - 1163WC1500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WC1500XNursing Service ProvidersRegistered NurseCommunity Health