Provider Demographics
NPI:1235645870
Name:THORNOCK, ANN RENAE (APNP - FAMILY)
Entity type:Individual
Prefix:
First Name:ANN
Middle Name:RENAE
Last Name:THORNOCK
Suffix:
Gender:F
Credentials:APNP - FAMILY
Other - Prefix:
Other - First Name:ANN
Other - Middle Name:RENAE
Other - Last Name:PARKER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:122 E. COLLEGE AVE
Mailing Address - Street 2:
Mailing Address - City:APPLETON
Mailing Address - State:WI
Mailing Address - Zip Code:54911
Mailing Address - Country:US
Mailing Address - Phone:920-831-1922
Mailing Address - Fax:
Practice Address - Street 1:100 COUNTY ROAD B
Practice Address - Street 2:
Practice Address - City:SHAWANO
Practice Address - State:WI
Practice Address - Zip Code:54166-7072
Practice Address - Country:US
Practice Address - Phone:715-524-2161
Practice Address - Fax:920-526-3461
Is Sole Proprietor?:Yes
Enumeration Date:2017-12-19
Last Update Date:2019-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI8062-33363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily