Provider Demographics
NPI:1083869325
Name:THORNTON, MICHELLE RENAE (RN)
Entity Type:Individual
Prefix:MRS
First Name:MICHELLE
Middle Name:RENAE
Last Name:THORNTON
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:MICHELLE
Other - Middle Name:RENAE
Other - Last Name:MORRISON
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:14307 300TH AVE
Mailing Address - Street 2:
Mailing Address - City:FRAZEE
Mailing Address - State:MN
Mailing Address - Zip Code:56544
Mailing Address - Country:US
Mailing Address - Phone:218-850-0618
Mailing Address - Fax:
Practice Address - Street 1:106 4TH AVE N
Practice Address - Street 2:
Practice Address - City:FERGUS FALLS
Practice Address - State:MN
Practice Address - Zip Code:56537-1034
Practice Address - Country:US
Practice Address - Phone:218-998-3778
Practice Address - Fax:218-998-3187
Is Sole Proprietor?:No
Enumeration Date:2008-12-01
Last Update Date:2008-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNR165191-1163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse