Provider Demographics
NPI:1063976769
Name:THORNE, CHANDRA AIESHA (LVN)
Entity type:Individual
Prefix:MS
First Name:CHANDRA
Middle Name:AIESHA
Last Name:THORNE
Suffix:
Gender:F
Credentials:LVN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9112 S WESTERN AVE
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90047-3518
Mailing Address - Country:US
Mailing Address - Phone:626-394-3372
Mailing Address - Fax:
Practice Address - Street 1:4434 HARDING AVE
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90066-6123
Practice Address - Country:US
Practice Address - Phone:310-988-8850
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-01-27
Last Update Date:2020-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAVN209080164X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164X00000XNursing Service ProvidersLicensed Vocational Nurse