Provider Demographics
NPI:1043813702
Name:THOMAS, JOY VONTRESE
Entity Type:Individual
Prefix:
First Name:JOY
Middle Name:VONTRESE
Last Name:THOMAS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2909 HOWDEN ST
Mailing Address - Street 2:
Mailing Address - City:MUSKEGON
Mailing Address - State:MI
Mailing Address - Zip Code:49444-2113
Mailing Address - Country:US
Mailing Address - Phone:231-683-8615
Mailing Address - Fax:
Practice Address - Street 1:2909 HOWDEN ST
Practice Address - Street 2:
Practice Address - City:MUSKEGON
Practice Address - State:MI
Practice Address - Zip Code:49444-2113
Practice Address - Country:US
Practice Address - Phone:231-683-8615
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-11-17
Last Update Date:2020-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246RP1900XTechnologists, Technicians & Other Technical Service ProvidersTechnician, PathologyPhlebotomy