Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NN1001X | Nutrition | LA |
NPI | 1164439055 |
---|---|
Provider Name | Dr. Roxanne C Thornton |
First Address | Saint Francisville, LA 70775-3114 |
Second Address | Saint Francisville, LA 70775 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 02/08/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
U45078 | (02) | LA |