Provider Demographics
NPI:1417628785
Name:THORNTON, KIMBERLEE (RN)
Entity Type:Individual
Prefix:
First Name:KIMBERLEE
Middle Name:
Last Name:THORNTON
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:727 NE ROSELAWN ST
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97211-3831
Mailing Address - Country:US
Mailing Address - Phone:610-639-8826
Mailing Address - Fax:
Practice Address - Street 1:727 NE ROSELAWN ST
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97211-3831
Practice Address - Country:US
Practice Address - Phone:610-639-8826
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-09-25
Last Update Date:2021-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program