Provider Demographics
NPI:1649294190
Name:THORNER, NANCY SHARON (MD)
Entity type:Individual
Prefix:DR
First Name:NANCY
Middle Name:SHARON
Last Name:THORNER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1667 DOMINICAN WAY
Mailing Address - Street 2:SUITE 234
Mailing Address - City:SANTA CRUZ
Mailing Address - State:CA
Mailing Address - Zip Code:95065-1518
Mailing Address - Country:US
Mailing Address - Phone:831-476-3363
Mailing Address - Fax:831-476-6837
Practice Address - Street 1:1667 DOMINICAN WAY
Practice Address - Street 2:SUITE 234
Practice Address - City:SANTA CRUZ
Practice Address - State:CA
Practice Address - Zip Code:95065-1518
Practice Address - Country:US
Practice Address - Phone:831-476-3363
Practice Address - Fax:831-476-6837
Is Sole Proprietor?:No
Enumeration Date:2006-07-27
Last Update Date:2012-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG57135174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G571350OtherMEDICARE ID
CAZZZ30143ZOtherMEDICARE GROUP NUMBER
CAZZZ30143ZOtherMEDICARE GROUP NUMBER