Individual
SIDNEY K HARNETIAUX THURSTON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
390 OFFICE CT, FAIRVIEW HEIGHTS, IL 62208-2059
(618) 233-7666
Mailing address
390 OFFICE CT, FAIRVIEW HEIGHTS, IL 62208-2059
(618) 233-7666
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
085011197
IL
Other
Enumeration date
04/07/2025
Last updated
09/01/2025
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