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General NPI Number Information
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NPI Number | 1629282603
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Entity Type | Individual
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Provider Name | COLLEEN HERTEN THORNTON CRNP
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Gender | Female
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Dates
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Enumeration Date | 05/09/2007
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Last Update Date | 11/27/2023
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Provider Practice Location Address
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Address Line | 300 W ROUTE 38 STE B
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City | MOORESTOWN
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State | NJ
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Zip | 08057-3424
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Country | US
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Telephone | 609-267-9400
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Fax |
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Provider Business Mailing Address
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Address Line | 301 LIPPINCOTT DR STE 410
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City | MARLTON
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State | NJ
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Zip | 08053-4197
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Country | US
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Telephone | 856-355-0340
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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 | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number | R161878
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License Number State | MD
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Taxonomy #2
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Taxonomy Code | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number | 26NJ00431500
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License Number State | NJ
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Taxonomy #3
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Taxonomy Code | 363LA2200X
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Taxonomy Name | Adult Health Nurse Practitioner
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License Number | SP010837
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License Number State | PA
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Taxonomy #4
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Taxonomy Code | 363LA2200X
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Taxonomy Name | Adult Health Nurse Practitioner
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License Number | 26NJ00431500
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License Number State | NJ
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