Provider Demographics
NPI:1700173556
Name:THURSTON, CHRISTINE W (D O)
Entity Type:Individual
Prefix:DR
First Name:CHRISTINE
Middle Name:W
Last Name:THURSTON
Suffix:
Gender:F
Credentials:D O
Other - Prefix:
Other - First Name:CHRISTINE
Other - Middle Name:ELIZABETH
Other - Last Name:WHITEHEAD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DO
Mailing Address - Street 1:201 SAINT ANN DR STE B
Mailing Address - Street 2:
Mailing Address - City:MANDEVILLE
Mailing Address - State:LA
Mailing Address - Zip Code:70471-3472
Mailing Address - Country:US
Mailing Address - Phone:985-626-1717
Mailing Address - Fax:
Practice Address - Street 1:201 SAINT ANN DR STE B
Practice Address - Street 2:
Practice Address - City:MANDEVILLE
Practice Address - State:LA
Practice Address - Zip Code:70471-3472
Practice Address - Country:US
Practice Address - Phone:985-626-1717
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-30
Last Update Date:2020-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA323614207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA323614OtherLA LICENSE