Provider Demographics
NPI:1871844662
Name:THORNTON, KATIE LYNN (RTR)
Entity Type:Individual
Prefix:MRS
First Name:KATIE
Middle Name:LYNN
Last Name:THORNTON
Suffix:
Gender:F
Credentials:RTR
Other - Prefix:MS
Other - First Name:KATIE
Other - Middle Name:LYNN
Other - Last Name:BARTON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:6905 E STATE ST
Mailing Address - Street 2:
Mailing Address - City:ROCKFORD
Mailing Address - State:IL
Mailing Address - Zip Code:61108-2692
Mailing Address - Country:US
Mailing Address - Phone:815-397-4142
Mailing Address - Fax:815-397-4144
Practice Address - Street 1:6905 E STATE ST
Practice Address - Street 2:
Practice Address - City:ROCKFORD
Practice Address - State:IL
Practice Address - Zip Code:61108-2692
Practice Address - Country:US
Practice Address - Phone:815-397-4142
Practice Address - Fax:815-397-4144
Is Sole Proprietor?:No
Enumeration Date:2012-09-20
Last Update Date:2012-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL500509356247100000X
247200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes247100000XTechnologists, Technicians & Other Technical Service ProvidersRadiologic Technologist
No247200000XTechnologists, Technicians & Other Technical Service ProvidersTechnician, Other
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL500509356OtherIEMA DIVISION OF NUCLEAR SAFETY