Provider Demographics
NPI:1326342056
Name:THOMAS, ANNAMMA (MA PARENT CHILD NURS)
Entity Type:Individual
Prefix:
First Name:ANNAMMA
Middle Name:
Last Name:THOMAS
Suffix:
Gender:F
Credentials:MA PARENT CHILD NURS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1905 COCHRAN ST
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89104-3538
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1516 E TROPICANA AVE
Practice Address - Street 2:SUITE 245
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89119-6525
Practice Address - Country:US
Practice Address - Phone:702-339-7697
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-01-10
Last Update Date:2011-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YM0800X
NVRN07059163WC1600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No163WC1600XNursing Service ProvidersRegistered NurseContinuing Education/Staff Development