Provider Demographics
NPI:1053487611
Name:THOMAS, MARICE (RN, FNP)
Entity Type:Individual
Prefix:
First Name:MARICE
Middle Name:
Last Name:THOMAS
Suffix:
Gender:F
Credentials:RN, FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2675 HARRIS ST
Mailing Address - Street 2:
Mailing Address - City:EUREKA
Mailing Address - State:CA
Mailing Address - Zip Code:95503-4806
Mailing Address - Country:US
Mailing Address - Phone:707-443-8335
Mailing Address - Fax:707-443-7327
Practice Address - Street 1:2675 HARRIS ST
Practice Address - Street 2:
Practice Address - City:EUREKA
Practice Address - State:CA
Practice Address - Zip Code:95503-4806
Practice Address - Country:US
Practice Address - Phone:707-443-8335
Practice Address - Fax:707-443-7327
Is Sole Proprietor?:No
Enumeration Date:2006-11-27
Last Update Date:2012-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CANPF10804363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAP42946Medicare UPIN