Provider Demographics
NPI:1245583699
Name:THORNBURY, DIANA L (RN, BSN)
Entity Type:Individual
Prefix:MRS
First Name:DIANA
Middle Name:L
Last Name:THORNBURY
Suffix:
Gender:F
Credentials:RN, BSN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:30800 TELEGRAPH RD STE 2800
Mailing Address - Street 2:
Mailing Address - City:BINGHAM FARMS
Mailing Address - State:MI
Mailing Address - Zip Code:48025-5704
Mailing Address - Country:US
Mailing Address - Phone:248-593-0100
Mailing Address - Fax:248-593-0200
Practice Address - Street 1:30800 TELEGRAPH RD STE 2800
Practice Address - Street 2:
Practice Address - City:BINGHAM FARMS
Practice Address - State:MI
Practice Address - Zip Code:48025-5704
Practice Address - Country:US
Practice Address - Phone:248-593-0100
Practice Address - Fax:248-593-0200
Is Sole Proprietor?:No
Enumeration Date:2012-10-23
Last Update Date:2012-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704159130163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4704159130OtherRN LICENSE