Provider Demographics
NPI:1063222198
Name:THORNOCK, MELISSA L
Entity type:Individual
Prefix:MRS
First Name:MELISSA
Middle Name:L
Last Name:THORNOCK
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:742 W 1600 N
Mailing Address - Street 2:
Mailing Address - City:OREM
Mailing Address - State:UT
Mailing Address - Zip Code:84057-2518
Mailing Address - Country:US
Mailing Address - Phone:801-362-0185
Mailing Address - Fax:
Practice Address - Street 1:276 E 950 S
Practice Address - Street 2:
Practice Address - City:OREM
Practice Address - State:UT
Practice Address - Zip Code:84058-7054
Practice Address - Country:US
Practice Address - Phone:801-845-4406
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-01-10
Last Update Date:2025-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program