Healthcare Provider Details

I. General information

NPI: 1396580312
Provider Name (Legal Business Name): CASSIDY JEAN THORNTON LPN, CLC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/01/2024
Last Update Date: 08/05/2026
Certification Date: 08/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

308 W ELM ST
ONEIDA NY
13421-1316
US

IV. Provider business mailing address

308 W ELM ST
ONEIDA NY
13421-1316
US

V. Phone/Fax

Practice location:
  • Phone: 315-761-2950
  • Fax:
Mailing address:
  • Phone: 315-761-2950
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174N00000X
TaxonomyLactation Consultant (Non-RN)
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code164W00000X
TaxonomyLicensed Practical Nurse
License Number346566
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: