Provider Demographics
NPI:1164609400
Name:THOMAS, BJARNI L (CNM, MS)
Entity Type:Individual
Prefix:
First Name:BJARNI
Middle Name:L
Last Name:THOMAS
Suffix:
Gender:F
Credentials:CNM, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:89 MAIN ST STE B
Mailing Address - Street 2:
Mailing Address - City:MACHIAS
Mailing Address - State:ME
Mailing Address - Zip Code:04654-1200
Mailing Address - Country:US
Mailing Address - Phone:207-255-0014
Mailing Address - Fax:207-255-0015
Practice Address - Street 1:89 MAIN ST STE B
Practice Address - Street 2:
Practice Address - City:MACHIAS
Practice Address - State:ME
Practice Address - Zip Code:04654-1200
Practice Address - Country:US
Practice Address - Phone:207-255-0014
Practice Address - Fax:207-255-0015
Is Sole Proprietor?:Yes
Enumeration Date:2008-01-29
Last Update Date:2023-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MECNM82078367A00000X
PAMW010455367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME134080000Medicaid
ME1164609400OtherNPI
WVTHNM03841Medicare PIN
WVQ46589BMedicare PIN
WVQ46589AMedicare PIN
ME134080000Medicaid
WVQ46589CMedicare PIN
WV3810015773Medicaid