Provider Demographics
NPI:1326883075
Name:THORNTON, KATRINA (RN)
Entity type:Individual
Prefix:
First Name:KATRINA
Middle Name:
Last Name:THORNTON
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1179 ROBINSON RD
Mailing Address - Street 2:
Mailing Address - City:ELM GROVE
Mailing Address - State:LA
Mailing Address - Zip Code:71051-8735
Mailing Address - Country:US
Mailing Address - Phone:715-892-8816
Mailing Address - Fax:
Practice Address - Street 1:1179 ROBINSON RD
Practice Address - Street 2:
Practice Address - City:ELM GROVE
Practice Address - State:LA
Practice Address - Zip Code:71051-8735
Practice Address - Country:US
Practice Address - Phone:715-892-8816
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-06-26
Last Update Date:2024-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LARN152002163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse