Provider Demographics
NPI:1225527781
Name:THOMAS, DEAIGNER
Entity Type:Individual
Prefix:
First Name:DEAIGNER
Middle Name:
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 1:7111 WOODROW AVE
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63121-5121
Mailing Address - Country:US
Mailing Address - Phone:314-546-6526
Mailing Address - Fax:
Practice Address - Street 1:100 CHESTERFIELD BUSINESS PKWY STE 200
Practice Address - Street 2:
Practice Address - City:CHESTERFIELD
Practice Address - State:MO
Practice Address - Zip Code:63005-1271
Practice Address - Country:US
Practice Address - Phone:314-435-8424
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-05-09
Last Update Date:2018-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker