Provider Demographics
NPI:1952033979
Name:THORNTON, LACI L (MSN, APRN, FNP-BC)
Entity Type:Individual
Prefix:
First Name:LACI
Middle Name:L
Last Name:THORNTON
Suffix:
Gender:F
Credentials:MSN, APRN, FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15549 LAKE LAWRENCE RD
Mailing Address - Street 2:
Mailing Address - City:LAWRENCEVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:62439-4722
Mailing Address - Country:US
Mailing Address - Phone:618-928-1530
Mailing Address - Fax:
Practice Address - Street 1:2290 S THEOBALD LN
Practice Address - Street 2:
Practice Address - City:VINCENNES
Practice Address - State:IN
Practice Address - Zip Code:47591-8027
Practice Address - Country:US
Practice Address - Phone:812-886-3000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-06-28
Last Update Date:2023-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL041348592163WP0807X
IN28177544A163WP0807X
IL209026582363LF0000X
IN71013870A363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No163WP0807XNursing Service ProvidersRegistered NursePsychiatric/Mental Health, Child & Adolescent
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL209026582OtherSTATE BOARD OF NURSING
IN71013870AOtherSTATE BOARD OF NURSING
IL041348592OtherSTATE BOARD OF NURSING
IN28177544AOtherSTATE BOARD OF NURSING