Thora House, FNP
Individual provider Active NPI Nurse Practitioner · Lincoln, ME
NPI 1083673966 · NPPES record last updated Mar 4, 2013
Key facts
- NPI
- 1083673966
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Nurse Practitioner 363L00000X
- License
- 025743 (ME)
- Practice address
- 175 West Broadway
Lincoln, ME 04457-0000 - Phone
- (207) 794-6700
- Fax
- (207) 794-6466
- NPI assigned
- Mar 21, 2006
- Sex
- Female
- Sole proprietor
- No
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Nurse Practitioner
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 025743 | ME | MD | Nurse Practitioner |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Nurse Practitioner | 363L00000X | 025743 | ME | Yes |
Addresses
Primary practice location
175 West Broadway
Lincoln, ME 04457-0000
Mailing address
PO Box 99
Lincoln, ME 04457-0099
Phone (207) 794-6700
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 201837 | Other | ME | NGS |
| 257420099 | Medicaid | ME | |
| 035045 | Other | ME | ANTHEM |
Other providers in Lincoln, ME
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Mar 4, 2013. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.