Provider Demographics
NPI:1356366371
Name:THORNTON, PATRICIA JANE (CNM)
Entity type:Individual
Prefix:MS
First Name:PATRICIA
Middle Name:JANE
Last Name:THORNTON
Suffix:
Gender:F
Credentials:CNM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 868
Mailing Address - Street 2:
Mailing Address - City:PINON
Mailing Address - State:AZ
Mailing Address - Zip Code:86510-0868
Mailing Address - Country:US
Mailing Address - Phone:520-906-6869
Mailing Address - Fax:
Practice Address - Street 1:PINON HEALTH CENTER
Practice Address - Street 2:INDIAN HEALTH SERVICE
Practice Address - City:PINON
Practice Address - State:AZ
Practice Address - Zip Code:86510
Practice Address - Country:US
Practice Address - Phone:928-725-9500
Practice Address - Fax:928-725-9540
Is Sole Proprietor?:No
Enumeration Date:2006-07-12
Last Update Date:2011-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZRN115723 AP1430367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ749195Medicaid
AZ749195Medicaid