Provider Demographics
NPI:1952988396
Name:THORNLEY, DANIEL BRYSON
Entity Type:Individual
Prefix:
First Name:DANIEL
Middle Name:BRYSON
Last Name:THORNLEY
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1973 MILLER RD
Mailing Address - Street 2:
Mailing Address - City:ADRIAN
Mailing Address - State:OR
Mailing Address - Zip Code:97901-5088
Mailing Address - Country:US
Mailing Address - Phone:208-919-4832
Mailing Address - Fax:
Practice Address - Street 1:1973 MILLER RD
Practice Address - Street 2:
Practice Address - City:ADRIAN
Practice Address - State:OR
Practice Address - Zip Code:97901-5088
Practice Address - Country:US
Practice Address - Phone:208-919-4832
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-03-24
Last Update Date:2021-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant