Provider Demographics
NPI:1902669583
Name:THORNLEY, CODY
Entity Type:Individual
Prefix:
First Name:CODY
Middle Name:
Last Name:THORNLEY
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:193 JACARANDA WAY
Mailing Address - Street 2:
Mailing Address - City:MESQUITE
Mailing Address - State:NV
Mailing Address - Zip Code:89027-6324
Mailing Address - Country:US
Mailing Address - Phone:435-623-7312
Mailing Address - Fax:
Practice Address - Street 1:193 JACARANDA WAY
Practice Address - Street 2:
Practice Address - City:MESQUITE
Practice Address - State:NV
Practice Address - Zip Code:89027-6324
Practice Address - Country:US
Practice Address - Phone:435-623-7312
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-02-05
Last Update Date:2024-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide