Provider Demographics
NPI:1346515889
Name:THORNOCK, DORIS FAYE
Entity Type:Individual
Prefix:
First Name:DORIS
Middle Name:FAYE
Last Name:THORNOCK
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:444 N 10TH ST
Mailing Address - Street 2:
Mailing Address - City:MONTPELIER
Mailing Address - State:ID
Mailing Address - Zip Code:83254-1115
Mailing Address - Country:US
Mailing Address - Phone:208-847-2623
Mailing Address - Fax:
Practice Address - Street 1:444 N 10TH ST
Practice Address - Street 2:
Practice Address - City:MONTPELIER
Practice Address - State:ID
Practice Address - Zip Code:83254-1115
Practice Address - Country:US
Practice Address - Phone:208-847-2623
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-03-16
Last Update Date:2012-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171W00000XOther Service ProvidersContractor