Basic Information
| Provider Information | |||||||||
| NPI: | 1598237067 | ||||||||
| EntityType: | 1 | ||||||||
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| LastName: | THYNE | ||||||||
| FirstName: | HEATHER | ||||||||
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| Credential: | ATC, PA-C | ||||||||
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| Mailing Information | |||||||||
| Address1: | 90 TENNYSON AVE | ||||||||
| Address2: | |||||||||
| City: | NASHUA | ||||||||
| State: | NH | ||||||||
| PostalCode: | 030622535 | ||||||||
| CountryCode: | US | ||||||||
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| Practice Location | |||||||||
| Address1: | 33 BARTLETT ST STE 206 | ||||||||
| Address2: | |||||||||
| City: | LOWELL | ||||||||
| State: | MA | ||||||||
| PostalCode: | 018521317 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9784581293 | ||||||||
| FaxNumber: | 9784586953 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/21/2018 | ||||||||
| LastUpdateDate: | 01/30/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 01/30/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363A00000X | MA | Y | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant |
No ID Information.