Basic Information
| Provider Information | |||||||||
| NPI: | 1568593994 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | THORSTENS | ||||||||
| FirstName: | MARILYN | ||||||||
| MiddleName: | G | ||||||||
| NamePrefix: | |||||||||
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| Credential: | RN | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1550 COLLEGE STREEET | ||||||||
| Address2: | |||||||||
| City: | MACON | ||||||||
| State: | GA | ||||||||
| PostalCode: | 312071554 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4783014111 | ||||||||
| FaxNumber: | 4783012387 | ||||||||
| Practice Location | |||||||||
| Address1: | 1550 COLLEGE STREEET | ||||||||
| Address2: | |||||||||
| City: | MACON | ||||||||
| State: | GA | ||||||||
| PostalCode: | 312071554 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4783014111 | ||||||||
| FaxNumber: | 4783012387 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/08/2007 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 163W00000X | RN065540 | GA | Y | Nursing Service Providers | Registered Nurse |
No ID Information.