Healthcare Provider Details

I. General information

NPI: 1205164340
Provider Name (Legal Business Name): MELISSA D THORNTON CRNA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/01/2009
Last Update Date: 09/08/2025
Certification Date: 09/08/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1025 MARSH ST
MANKATO MN
56001-4752
US

IV. Provider business mailing address

PO BOX 1373
MANKATO MN
56002-1373
US

V. Phone/Fax

Practice location:
  • Phone: 507-385-2623
  • Fax:
Mailing address:
  • Phone: 507-385-2623
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number1216
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: