Healthcare Provider Details

I. General information

NPI: 1952530750
Provider Name (Legal Business Name): WILLIAM FREDERICK THORNTON
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/14/2009
Last Update Date: 03/17/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1031 7TH ST NE
DEVILS LAKE ND
58301-2719
US

IV. Provider business mailing address

105 21ST ST NE
DEVILS LAKE ND
58301-1627
US

V. Phone/Fax

Practice location:
  • Phone: 701-662-2131
  • Fax: 701-662-9651
Mailing address:
  • Phone: 701-662-4202
  • Fax: 701-662-4202

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number209007663
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number103222
License Number StateMT
# 3
Primary TaxonomyN
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number96024
License Number StateWV
# 4
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberR44275
License Number StateND

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: