Provider Demographics
NPI:1144583568
Name:THOMAS, KERRI MARIE
Entity Type:Individual
Prefix:
First Name:KERRI
Middle Name:MARIE
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 1:3456 GALE AVE
Mailing Address - Street 2:
Mailing Address - City:LONG BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90810-2232
Mailing Address - Country:US
Mailing Address - Phone:310-819-0255
Mailing Address - Fax:
Practice Address - Street 1:100 W BROADWAY
Practice Address - Street 2:SUITE 5005
Practice Address - City:LONG BEACH
Practice Address - State:CA
Practice Address - Zip Code:90802-4431
Practice Address - Country:US
Practice Address - Phone:562-285-1330
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-06-20
Last Update Date:2012-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAVN209449164X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164X00000XNursing Service ProvidersLicensed Vocational Nurse