Basic Information
| Provider Information | |||||||||
| NPI: | 1225677396 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | THORNTON | ||||||||
| FirstName: | CARRIE | ||||||||
| MiddleName: | F | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1301 S KOKE MILL RD | ||||||||
| Address2: | |||||||||
| City: | SPRINGFIELD | ||||||||
| State: | IL | ||||||||
| PostalCode: | 627119252 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2175479100 | ||||||||
| FaxNumber: | 2175479236 | ||||||||
| Practice Location | |||||||||
| Address1: | 1301 S KOKE MILL RD | ||||||||
| Address2: | |||||||||
| City: | SPRINGFIELD | ||||||||
| State: | IL | ||||||||
| PostalCode: | 627119252 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2175479100 | ||||||||
| FaxNumber: | 2175479236 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/06/2020 | ||||||||
| LastUpdateDate: | 01/06/2020 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 01/06/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 163WR0006X | 041326468 | IL | Y | Nursing Service Providers | Registered Nurse | Registered Nurse First Assistant |
No ID Information.