Provider Demographics
NPI:1063055622
Name:THORNTON, BETH K (CNP)
Entity type:Individual
Prefix:MRS
First Name:BETH
Middle Name:K
Last Name:THORNTON
Suffix:
Gender:F
Credentials:CNP
Other - Prefix:
Other - First Name:BETH
Other - Middle Name:K
Other - Last Name:BOSTATER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CNP
Mailing Address - Street 1:9741 FAIRMEADOWS LN
Mailing Address - Street 2:
Mailing Address - City:WHITEHOUSE
Mailing Address - State:OH
Mailing Address - Zip Code:43571-9017
Mailing Address - Country:US
Mailing Address - Phone:419-214-0330
Mailing Address - Fax:567-316-6451
Practice Address - Street 1:2519 OREGON RD
Practice Address - Street 2:
Practice Address - City:NORTHWOOD
Practice Address - State:OH
Practice Address - Zip Code:43619-1001
Practice Address - Country:US
Practice Address - Phone:419-214-0330
Practice Address - Fax:567-316-6451
Is Sole Proprietor?:Yes
Enumeration Date:2019-10-25
Last Update Date:2024-12-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHAPRN.CNP.025858363LF0000X
MI4704263614363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily