Provider Demographics
NPI:1174613087
Name:THORSON, S JANINE (NP)
Entity type:Individual
Prefix:
First Name:S
Middle Name:JANINE
Last Name:THORSON
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:28780 SINGLE OAK DR STE 260
Mailing Address - Street 2:
Mailing Address - City:TEMECULA
Mailing Address - State:CA
Mailing Address - Zip Code:92590-5534
Mailing Address - Country:US
Mailing Address - Phone:951-676-4193
Mailing Address - Fax:951-252-8668
Practice Address - Street 1:31150 TEMECULA PKWY STE 200
Practice Address - Street 2:
Practice Address - City:TEMECULA
Practice Address - State:CA
Practice Address - Zip Code:92592-2921
Practice Address - Country:US
Practice Address - Phone:951-676-4193
Practice Address - Fax:951-252-8668
Is Sole Proprietor?:No
Enumeration Date:2006-10-13
Last Update Date:2020-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CANP9781363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily