Provider Demographics
NPI:1528738960
Name:THORNTON, NICHOLE I (LPN)
Entity type:Individual
Prefix:
First Name:NICHOLE
Middle Name:I
Last Name:THORNTON
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1856 IRWIN DR BLDG 1058
Mailing Address - Street 2:
Mailing Address - City:FORT CARSON
Mailing Address - State:CO
Mailing Address - Zip Code:80913-4176
Mailing Address - Country:US
Mailing Address - Phone:719-524-5268
Mailing Address - Fax:719-526-2709
Practice Address - Street 1:1856 IRWIN DR BLDG 1058
Practice Address - Street 2:
Practice Address - City:FORT CARSON
Practice Address - State:CO
Practice Address - Zip Code:80913-4176
Practice Address - Country:US
Practice Address - Phone:719-524-5268
Practice Address - Fax:719-526-2709
Is Sole Proprietor?:No
Enumeration Date:2021-09-16
Last Update Date:2021-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO36454164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse