Individual
CODY JACOB THORSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA-C
Contact information
Practice address
4920 S 30TH ST STE 103, OMAHA, NE 68107-1656
(402) 734-4110
(402) 734-3990
Mailing address
4920 S 30TH ST STE 103, OMAHA, NE 68107-1656
(402) 734-4110
(402) 401-6005
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
2428
NE
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2428
NEBRASKA DEPARTMENT OF HEALTH AND HUMAN SERVICES LICENSURE
NE
Enumeration date
01/22/2020
Last updated
02/03/2023
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