Provider Demographics
NPI:1275511354
Name:THOMAS, SUE A (RN, NP)
Entity Type:Individual
Prefix:MS
First Name:SUE
Middle Name:A
Last Name:THOMAS
Suffix:
Gender:F
Credentials:RN, NP
Other - Prefix:MS
Other - First Name:SUE
Other - Middle Name:A
Other - Last Name:SWEENEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN, NP, CNM
Mailing Address - Street 1:10786 N EAGLE CREST LN
Mailing Address - Street 2:
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93720-3594
Mailing Address - Country:US
Mailing Address - Phone:559-433-9307
Mailing Address - Fax:
Practice Address - Street 1:6730 N WEST AVE
Practice Address - Street 2:STE 115
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93711-4301
Practice Address - Country:US
Practice Address - Phone:559-261-9320
Practice Address - Fax:559-261-9324
Is Sole Proprietor?:No
Enumeration Date:2006-01-09
Last Update Date:2014-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA6243363LX0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LX0001XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAP23537Medicare UPIN
CAZZZ19920ZMedicare ID - Type UnspecifiedPROVIDER ID NUMBER