Healthcare Provider Details

I. General information

NPI: 1073436036
Provider Name (Legal Business Name): AUTUM THORPE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/04/2026
Last Update Date: 08/04/2026
Certification Date: 08/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

300 S 20TH ST APT 2
HERRIN IL
62948-2241
US

IV. Provider business mailing address

300 S 20TH ST APT 2
HERRIN IL
62948-2241
US

V. Phone/Fax

Practice location:
  • Phone: 618-513-1758
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code164W00000X
TaxonomyLicensed Practical Nurse
License Number043616293
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: