Provider Demographics
NPI:1962655092
Name:THORNLEY, LISBETH CAROLINE (CRNP)
Entity type:Individual
Prefix:
First Name:LISBETH
Middle Name:CAROLINE
Last Name:THORNLEY
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 366
Mailing Address - Street 2:
Mailing Address - City:DORA
Mailing Address - State:AL
Mailing Address - Zip Code:35062-0366
Mailing Address - Country:US
Mailing Address - Phone:205-648-7887
Mailing Address - Fax:205-648-5115
Practice Address - Street 1:497 MAIN ST
Practice Address - Street 2:
Practice Address - City:SUMITON
Practice Address - State:AL
Practice Address - Zip Code:35148-4328
Practice Address - Country:US
Practice Address - Phone:205-648-7887
Practice Address - Fax:205-648-5115
Is Sole Proprietor?:No
Enumeration Date:2008-11-03
Last Update Date:2008-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1-104066363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily