Healthcare Provider Details

I. General information

NPI: 1104753086
Provider Name (Legal Business Name): LISA ANN THORNTON BSN, RN, LSN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/06/2026
Last Update Date: 05/06/2026
Certification Date: 05/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1500 TIBBETTS AVE
SPRINGFIELD OH
45505-3851
US

IV. Provider business mailing address

1500 TIBBETTS AVE
SPRINGFIELD OH
45505-3851
US

V. Phone/Fax

Practice location:
  • Phone: 937-505-4261
  • Fax: 937-505-2913
Mailing address:
  • Phone: 937-505-4261
  • Fax: 937-505-2913

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WS0200X
TaxonomySchool Registered Nurse
License NumberRN.310818
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: