Healthcare Provider Details

I. General information

NPI: 1558388512
Provider Name (Legal Business Name): PATTY ANNE THORNTON PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/16/2006
Last Update Date: 05/31/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

92 ALLEN ST
RUTLAND VT
05701
US

IV. Provider business mailing address

92 ALLEN ST
RUTLAND VT
05701-4562
US

V. Phone/Fax

Practice location:
  • Phone: 802-776-4045
  • Fax: 802-773-7922
Mailing address:
  • Phone: 802-776-4045
  • Fax: 802-773-7922

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number0550030866
License Number StateVT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: