MEDICARE: NICHOLE I. THORNTON LPN

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	164W00000X	Licensed Practical Nurse	36454	CO

General Provider Information

NPI Number	:	1528738960
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	NICHOLE I. THORNTON LPN

Provider Business Mailing Address
First Line	:	1856 IRWIN DR BLDG 1058
Second Line	:
City	:	FORT CARSON
State	:	CO
Zip	:	80913-4176
Country	:	US
Telephone Number	:	719-524-5268
Fax Number	:	719-526-2709

Provider Business Practice Location Address
First Line	:	1856 IRWIN DR BLDG 1058
Second Line	:
City	:	FORT CARSON
State	:	CO
Zip	:	80913-4176
Country	:	US
Telephone Number	:	719-524-5268
Fax Number	:	719-526-2709

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/16/2021
Last Update Date	:	09/16/2021

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