Provider Demographics
NPI:1235677089
Name:THOMSON, SISLY (RN, NP-C)
Entity Type:Individual
Prefix:
First Name:SISLY
Middle Name:
Last Name:THOMSON
Suffix:
Gender:F
Credentials:RN, NP-C
Other - Prefix:
Other - First Name:SISLY
Other - Middle Name:M
Other - Last Name:PAREECKAMOLEL
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:RN
Mailing Address - Street 1:41 PASADENA DR
Mailing Address - Street 2:
Mailing Address - City:PLAINVIEW
Mailing Address - State:NY
Mailing Address - Zip Code:11803-3729
Mailing Address - Country:US
Mailing Address - Phone:516-282-6850
Mailing Address - Fax:
Practice Address - Street 1:41 PASADENA DR
Practice Address - Street 2:
Practice Address - City:PLAINVIEW
Practice Address - State:NY
Practice Address - Zip Code:11803-3729
Practice Address - Country:US
Practice Address - Phone:516-282-6850
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-02-01
Last Update Date:2017-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY572862163W00000X
NYF307750363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
No163W00000XNursing Service ProvidersRegistered Nurse