Provider Demographics
NPI:1528519519
Name:THORNE, NICHOLE (FNP, PMHNP)
Entity type:Individual
Prefix:MRS
First Name:NICHOLE
Middle Name:
Last Name:THORNE
Suffix:
Gender:F
Credentials:FNP, PMHNP
Other - Prefix:
Other - First Name:NICHOLE
Other - Middle Name:MICHELE
Other - Last Name:PETRIE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:1600 BROADWAY STE 1600
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80202-4916
Mailing Address - Country:US
Mailing Address - Phone:619-639-9730
Mailing Address - Fax:619-374-1359
Practice Address - Street 1:1600 BROADWAY STE 1600
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80202-4916
Practice Address - Country:US
Practice Address - Phone:619-639-9730
Practice Address - Fax:619-374-1359
Is Sole Proprietor?:Yes
Enumeration Date:2016-10-14
Last Update Date:2023-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95010881363LF0000X, 363LP0808X
NV815623363LP0808X, 363LF0000X
CO0998004363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily