Individual
TY D THORNOCK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
CRNA
Contact information
Practice address
100 COUNTY ROAD B, SHAWANO, WI 54166-7072
(715) 524-2161
Mailing address
122 E COLLEGE AVE, APPLETON, WI 54911-5794
(920) 996-3264
(920) 830-5970
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
Primary
2685-033
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
43382500
—
WI
Enumeration date
08/09/2006
Last updated
03/17/2018
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