Provider Demographics
NPI:1558388512
Name:THORNTON, PATTY ANNE (PA-C)
Entity Type:Individual
Prefix:
First Name:PATTY
Middle Name:ANNE
Last Name:THORNTON
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:92 ALLEN ST
Mailing Address - Street 2:
Mailing Address - City:RUTLAND
Mailing Address - State:VT
Mailing Address - Zip Code:05701-4562
Mailing Address - Country:US
Mailing Address - Phone:802-776-4045
Mailing Address - Fax:802-773-7922
Practice Address - Street 1:92 ALLEN ST
Practice Address - Street 2:
Practice Address - City:RUTLAND
Practice Address - State:VT
Practice Address - Zip Code:05701
Practice Address - Country:US
Practice Address - Phone:802-776-4045
Practice Address - Fax:802-773-7922
Is Sole Proprietor?:No
Enumeration Date:2006-07-16
Last Update Date:2019-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT0550030866363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
VTOAP0583Medicaid
VTS37205Medicare UPIN
VTOAP0583Medicaid
VTAP0583Medicare ID - Type Unspecified