Provider Demographics
NPI:1740310309
Name:THURSTON, MARGARET ANNE (LM)
Entity type:Individual
Prefix:
First Name:MARGARET
Middle Name:ANNE
Last Name:THURSTON
Suffix:
Gender:F
Credentials:LM
Other - Prefix:
Other - First Name:PEGGY
Other - Middle Name:
Other - Last Name:THURSTON
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LM
Mailing Address - Street 1:PO BOX 1354
Mailing Address - Street 2:
Mailing Address - City:SUQUAMISH
Mailing Address - State:WA
Mailing Address - Zip Code:98392-1354
Mailing Address - Country:US
Mailing Address - Phone:360-598-4727
Mailing Address - Fax:
Practice Address - Street 1:11698 NE SUNSET LOOP
Practice Address - Street 2:
Practice Address - City:BAINBRIDGE ISLAND
Practice Address - State:WA
Practice Address - Zip Code:98110-4290
Practice Address - Country:US
Practice Address - Phone:360-598-4727
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-06
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMW00000208176B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes176B00000XOther Service ProvidersMidwife
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA7086861Medicaid