Provider Demographics
NPI:1942530738
Name:ROGERS THORNTON, NANNETTE JANE (RD/CDE)
Entity type:Individual
Prefix:
First Name:NANNETTE
Middle Name:JANE
Last Name:ROGERS THORNTON
Suffix:
Gender:F
Credentials:RD/CDE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:311 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:NEW MADRID
Mailing Address - State:MO
Mailing Address - Zip Code:63869-1942
Mailing Address - Country:US
Mailing Address - Phone:573-748-2404
Mailing Address - Fax:573-748-2554
Practice Address - Street 1:421 LINE ST
Practice Address - Street 2:
Practice Address - City:NEW MADRID
Practice Address - State:MO
Practice Address - Zip Code:63869-1733
Practice Address - Country:US
Practice Address - Phone:573-748-2592
Practice Address - Fax:573-748-2673
Is Sole Proprietor?:No
Enumeration Date:2009-12-30
Last Update Date:2009-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO355856808Medicaid