Provider Demographics
NPI:1790599744
Name:THORSEN, AMBER MICHELLE (WHNP)
Entity type:Individual
Prefix:
First Name:AMBER
Middle Name:MICHELLE
Last Name:THORSEN
Suffix:
Gender:
Credentials:WHNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17102 ALYDAR COMMONS LN
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28278-8792
Mailing Address - Country:US
Mailing Address - Phone:540-797-4723
Mailing Address - Fax:
Practice Address - Street 1:1025 MOREHEAD MEDICAL DR STE 500
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28204-2968
Practice Address - Country:US
Practice Address - Phone:704-355-3149
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-02-01
Last Update Date:2025-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC5021587363LW0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health