Provider Demographics
NPI:1083056519
Name:THOMAS, ROBBIE DIANE
Entity Type:Individual
Prefix:
First Name:ROBBIE
Middle Name:DIANE
Last Name:THOMAS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:ROBBIE
Other - Middle Name:DIANE
Other - Last Name:THOMAS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1200 W CHEYENNE AVE
Mailing Address - Street 2:# 1041
Mailing Address - City:NORTH LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89030-7819
Mailing Address - Country:US
Mailing Address - Phone:702-782-4562
Mailing Address - Fax:
Practice Address - Street 1:1200 W CHEYENNE AVE
Practice Address - Street 2:# 1041
Practice Address - City:NORTH LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89030-7819
Practice Address - Country:US
Practice Address - Phone:702-782-4562
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-07-25
Last Update Date:2014-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV372500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes372500000XNursing Service Related ProvidersChore Provider