Provider Demographics
NPI:1457071268
Name:THORN, TINA RENEE
Entity Type:Individual
Prefix:
First Name:TINA
Middle Name:RENEE
Last Name:THORN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2224 AMERICANA DR
Mailing Address - Street 2:
Mailing Address - City:ROSEVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:95747-7602
Mailing Address - Country:US
Mailing Address - Phone:916-884-3777
Mailing Address - Fax:
Practice Address - Street 1:2224 AMERICANA DR
Practice Address - Street 2:
Practice Address - City:ROSEVILLE
Practice Address - State:CA
Practice Address - Zip Code:95747-7602
Practice Address - Country:US
Practice Address - Phone:916-884-3777
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-08-31
Last Update Date:2022-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator