Individual
MRS. BREANNA MARIE THORNTON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
1001 MILITARY ST, PORT HURON, MI 48060-5416
(810) 985-5168
(800) 248-1568
Mailing address
1255 ASPEN DR, #3, MARYSVILLE, MI 48040-2428
(810) 941-7478
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
382230613
FIN #
MI
Enumeration date
05/10/2012
Last updated
05/10/2012
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