Provider Demographics
NPI:1982887659
Name:THORN, VALERIE LEE (FNP-BC/PMHNP-BC)
Entity Type:Individual
Prefix:
First Name:VALERIE
Middle Name:LEE
Last Name:THORN
Suffix:
Gender:F
Credentials:FNP-BC/PMHNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11203 WELTY LN
Mailing Address - Street 2:
Mailing Address - City:AUBURN
Mailing Address - State:CA
Mailing Address - Zip Code:95603-9702
Mailing Address - Country:US
Mailing Address - Phone:219-781-0599
Mailing Address - Fax:
Practice Address - Street 1:1225 W 190TH ST
Practice Address - Street 2:
Practice Address - City:GARDENA
Practice Address - State:CA
Practice Address - Zip Code:90248-4320
Practice Address - Country:US
Practice Address - Phone:811-331-0515
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-12-17
Last Update Date:2022-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN71002049A363LF0000X
IL209.006888363LF0000X
IN71002049B363LF0000X
IL209006888363LF0000X
CA95014967363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
INR01241Medicare UPIN
ILR01241Medicare UPIN
INR01242Medicare UPIN
ILR01242Medicare UPIN