Provider Demographics
NPI:1386882561
Name:THORNTON, MARY ANN (LPN)
Entity type:Individual
Prefix:
First Name:MARY ANN
Middle Name:
Last Name:THORNTON
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2474 MONMOUTH RD
Mailing Address - Street 2:
Mailing Address - City:JOBSTOWN
Mailing Address - State:NJ
Mailing Address - Zip Code:08041-2027
Mailing Address - Country:US
Mailing Address - Phone:800-950-6066
Mailing Address - Fax:
Practice Address - Street 1:2474 MONMOUTH RD
Practice Address - Street 2:
Practice Address - City:JOBSTOWN
Practice Address - State:NJ
Practice Address - Zip Code:08041-2027
Practice Address - Country:US
Practice Address - Phone:800-950-6066
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-01-27
Last Update Date:2009-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NE00980400164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse