1831624626 NPI number — CATRICE MORNING BIRD THORNTON LMT

Table of content: CATRICE MORNING BIRD THORNTON LMT (NPI 1831624626)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1831624626 NPI number — CATRICE MORNING BIRD THORNTON LMT

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
THORNTON
Provider First Name:
CATRICE
Provider Middle Name:
MORNING BIRD
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
LMT
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1831624626
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
04/30/2017
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2050 BRETON RD SE
Provider Second Line Business Mailing Address:
SUITE 109
Provider Business Mailing Address City Name:
GRAND RAPIDS
Provider Business Mailing Address State Name:
MI
Provider Business Mailing Address Postal Code:
49546-5572
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
616-613-6442
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2050 BRETON RD SE
Provider Second Line Business Practice Location Address:
SUITE 109
Provider Business Practice Location Address City Name:
GRAND RAPIDS
Provider Business Practice Location Address State Name:
MI
Provider Business Practice Location Address Postal Code:
49546-5572
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
616-613-6442
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
04/29/2017

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 225700000X , with the licence number:  7501009142 , registered in the state of MI ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 175F00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)





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