Provider Demographics
NPI:1740808781
Name:THORNTON, ERICA
Entity type:Individual
Prefix:
First Name:ERICA
Middle Name:
Last Name:THORNTON
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 1:5525 CROSSCREEK LN APT 1110
Mailing Address - Street 2:
Mailing Address - City:BENBROOK
Mailing Address - State:TX
Mailing Address - Zip Code:76109-5839
Mailing Address - Country:US
Mailing Address - Phone:318-493-1821
Mailing Address - Fax:
Practice Address - Street 1:5525 CROSSCREEK LN APT 1110
Practice Address - Street 2:
Practice Address - City:BENBROOK
Practice Address - State:TX
Practice Address - Zip Code:76109-5839
Practice Address - Country:US
Practice Address - Phone:318-493-1821
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-07-07
Last Update Date:2020-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX351422164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse