Provider Demographics
NPI:1801123922
Name:THOREEN, JESSICA MICHELLE (APRN)
Entity type:Individual
Prefix:
First Name:JESSICA
Middle Name:MICHELLE
Last Name:THOREEN
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:JESSICA
Other - Middle Name:MICHELLE
Other - Last Name:ROWE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:60 COMMERCIAL ST STE 404
Mailing Address - Street 2:
Mailing Address - City:CONCORD
Mailing Address - State:NH
Mailing Address - Zip Code:03301-5096
Mailing Address - Country:US
Mailing Address - Phone:603-228-1763
Mailing Address - Fax:603-227-7539
Practice Address - Street 1:60 COMMERCIAL ST STE 404
Practice Address - Street 2:
Practice Address - City:CONCORD
Practice Address - State:NH
Practice Address - Zip Code:03301-5096
Practice Address - Country:US
Practice Address - Phone:603-228-1763
Practice Address - Fax:603-227-7539
Is Sole Proprietor?:Yes
Enumeration Date:2009-11-10
Last Update Date:2024-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI166285-030163W00000X
NH081302-23363LF0000X, 363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No163W00000XNursing Service ProvidersRegistered Nurse
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily