Provider Demographics
NPI:1710708938
Name:THORNTON, CALLIE
Entity type:Individual
Prefix:
First Name:CALLIE
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:PO BOX 96
Mailing Address - Street 2:
Mailing Address - City:RUDOLPH
Mailing Address - State:OH
Mailing Address - Zip Code:43462-0096
Mailing Address - Country:US
Mailing Address - Phone:419-601-8905
Mailing Address - Fax:
Practice Address - Street 1:PO BOX 96
Practice Address - Street 2:
Practice Address - City:RUDOLPH
Practice Address - State:OH
Practice Address - Zip Code:43462-0096
Practice Address - Country:US
Practice Address - Phone:419-601-8905
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-10-21
Last Update Date:2024-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376J00000XNursing Service Related ProvidersHomemaker