Provider Demographics
NPI:1235766734
Name:THORNBURG, ALLIE THERESE (PA-C)
Entity type:Individual
Prefix:
First Name:ALLIE
Middle Name:THERESE
Last Name:THORNBURG
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:ALLIE
Other - Middle Name:THERESE
Other - Last Name:FUNKE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:1500 ASSOCIATES DR
Mailing Address - Street 2:
Mailing Address - City:DUBUQUE
Mailing Address - State:IA
Mailing Address - Zip Code:52002-2201
Mailing Address - Country:US
Mailing Address - Phone:563-584-4370
Mailing Address - Fax:563-584-4232
Practice Address - Street 1:1500 ASSOCIATES DR
Practice Address - Street 2:
Practice Address - City:DUBUQUE
Practice Address - State:IA
Practice Address - Zip Code:52002-2201
Practice Address - Country:US
Practice Address - Phone:563-584-4370
Practice Address - Fax:563-584-4232
Is Sole Proprietor?:No
Enumeration Date:2020-03-25
Last Update Date:2024-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA101969363AM0700X, 363A00000X, 363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical