Provider Demographics
NPI:1326421579
Name:THOMAS, JUSTINE (RN)
Entity Type:Individual
Prefix:MS
First Name:JUSTINE
Middle Name:
Last Name:THOMAS
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2280 CESSNA DR
Mailing Address - Street 2:
Mailing Address - City:TWIN LAKE
Mailing Address - State:MI
Mailing Address - Zip Code:49457-8989
Mailing Address - Country:US
Mailing Address - Phone:231-724-3602
Mailing Address - Fax:231-724-3327
Practice Address - Street 1:2280 CESSNA DR
Practice Address - Street 2:
Practice Address - City:TWIN LAKE
Practice Address - State:MI
Practice Address - Zip Code:49457-8989
Practice Address - Country:US
Practice Address - Phone:231-724-3602
Practice Address - Fax:231-724-3327
Is Sole Proprietor?:No
Enumeration Date:2015-07-07
Last Update Date:2015-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704303747163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse