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Contact Information

MARYBETH THORN, PA-C
5904 HOLLY AVE NE
ALBUQUERQUE, NM87113-2472
 Phone: 505-298-2505
 Fax: 505-298-2985
 Website:
 

Specialty

Taxonomy Code Specialty Code Provider Type

Physician Assistant

363A00000X 97 Physician Assistant
 

Medical

363AM0700X 97 Physician Assistant
Indicates primary specialty

NPI Profile & details for MARYBETH THORN · (Female)

NPI # 1730253063
Status Active
Credentials PA-C (Physician Assistant-Certified)
Entity Individual
Enumeration date 11/20/2006
Last updated 04/07/2021 - About 5 years ago
Sole proprietor 1 No
Identifiers
  • CO License # 244
  • NC License # 102676
  • NM License # 86-PA052
  • CO Medicaid 91407770
  • CO Other PA244 COLORADO LICENSE
  • NC Other 102676 NC LICENSE
Hospital affiliation(s) Not Available
1 A sole proprietor/sole proprietorship is an individual, and as such, is eligible for a single NPI number. The sole proprietor must apply for the NPI number using his or her own Social Security Number (SSN), not an Employer Identification Number (EIN) even if he/she has an EIN.

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