Provider Demographics
NPI:1225691850
Name:THORNE, MICHELLE R (FNP-BC)
Entity Type:Individual
Prefix:
First Name:MICHELLE
Middle Name:R
Last Name:THORNE
Suffix:
Gender:F
Credentials:FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:190 E MICHIGAN AVE
Mailing Address - Street 2:
Mailing Address - City:BATTLE CREEK
Mailing Address - State:MI
Mailing Address - Zip Code:49014-4005
Mailing Address - Country:US
Mailing Address - Phone:269-969-6334
Mailing Address - Fax:269-969-6488
Practice Address - Street 1:190 E MICHIGAN AVE
Practice Address - Street 2:
Practice Address - City:BATTLE CREEK
Practice Address - State:MI
Practice Address - Zip Code:49014-4005
Practice Address - Country:US
Practice Address - Phone:269-969-6334
Practice Address - Fax:269-969-6488
Is Sole Proprietor?:No
Enumeration Date:2019-04-18
Last Update Date:2019-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI19100080435363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily