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General NPI Number Information
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NPI Number | 1235645870
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Entity Type | Individual
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Provider Name | ANN RENAE THORNOCK APNP - FAMILY
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Gender | Female
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Dates
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Enumeration Date | 12/19/2017
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Last Update Date | 09/02/2019
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Provider Practice Location Address
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Address Line | 100 COUNTY ROAD B
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City | SHAWANO
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State | WI
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Zip | 54166-7072
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Country | US
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Telephone | 715-524-2161
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Fax | 920-526-3461
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Provider Business Mailing Address
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Address Line | 122 E. COLLEGE AVE
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City | APPLETON
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State | WI
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Zip | 54911
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Country | US
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Telephone | 920-831-1922
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 8062-33
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License Number State | WI
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