Individual
GARY THORNBERG
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
CRNA
Contact information
Practice address
149 NORTH ST, WATERVILLE, ME 04901-4974
(207) 622-1959
(207) 430-4007
Mailing address
35 MEDICAL CENTER PKWY, AUGUSTA, ME 04330-8160
(207) 622-1959
(207) 430-4007
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
Primary
025911
ME
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
274300099
—
ME
Enumeration date
06/05/2006
Last updated
12/18/2013
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