Provider Demographics
NPI:1245755826
Name:THORNE, JOEL EDWARD (RN)
Entity Type:Individual
Prefix:
First Name:JOEL
Middle Name:EDWARD
Last Name:THORNE
Suffix:
Gender:M
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1823 HESSEN RD
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:MI
Mailing Address - Zip Code:48063-3223
Mailing Address - Country:US
Mailing Address - Phone:810-223-8705
Mailing Address - Fax:
Practice Address - Street 1:1221 PINE GROVE AVE
Practice Address - Street 2:
Practice Address - City:PORT HURON
Practice Address - State:MI
Practice Address - Zip Code:48060-3511
Practice Address - Country:US
Practice Address - Phone:810-987-5000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-08-04
Last Update Date:2017-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704289643163WC0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WC0200XNursing Service ProvidersRegistered NurseCritical Care Medicine