Provider Demographics
NPI:1952848756
Name:THORNTON, JOAN (LPN)
Entity Type:Individual
Prefix:
First Name:JOAN
Middle Name:
Last Name:THORNTON
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:743 RUSSELL AVE
Mailing Address - Street 2:
Mailing Address - City:WINTHROP HARBOR
Mailing Address - State:IL
Mailing Address - Zip Code:60096-1544
Mailing Address - Country:US
Mailing Address - Phone:847-309-6609
Mailing Address - Fax:
Practice Address - Street 1:743 RUSSELL AVE
Practice Address - Street 2:
Practice Address - City:WINTHROP HARBOR
Practice Address - State:IL
Practice Address - Zip Code:60096-1544
Practice Address - Country:US
Practice Address - Phone:847-309-6609
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-01-31
Last Update Date:2017-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL043030318164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse