Provider Demographics
NPI:1225802077
Name:THOMAS, JUSTINE PEARL (RN, CNP)
Entity Type:Individual
Prefix:
First Name:JUSTINE
Middle Name:PEARL
Last Name:THOMAS
Suffix:
Gender:F
Credentials:RN, CNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:6485 CITY WEST PKWY
Mailing Address - Street 2:
Mailing Address - City:EDEN PRAIRIE
Mailing Address - State:MN
Mailing Address - Zip Code:55344-3246
Mailing Address - Country:US
Mailing Address - Phone:952-933-1150
Mailing Address - Fax:952-930-3304
Practice Address - Street 1:6485 CITY WEST PKWY
Practice Address - Street 2:
Practice Address - City:EDEN PRAIRIE
Practice Address - State:MN
Practice Address - Zip Code:55344-3246
Practice Address - Country:US
Practice Address - Phone:952-933-1150
Practice Address - Fax:952-930-3304
Is Sole Proprietor?:No
Enumeration Date:2023-11-13
Last Update Date:2023-11-13
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MN9897363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner