Provider Demographics
NPI:1346248739
Name:THOMAS-ROBERTS, MARSHA VICTORIA (DIRECTOR)
Entity Type:Individual
Prefix:MRS
First Name:MARSHA
Middle Name:VICTORIA
Last Name:THOMAS-ROBERTS
Suffix:
Gender:F
Credentials:DIRECTOR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:23 N OAKS PLZ
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63121-2917
Mailing Address - Country:US
Mailing Address - Phone:314-382-9700
Mailing Address - Fax:314-385-2500
Practice Address - Street 1:23 N OAKS PLZ
Practice Address - Street 2:SUITE 250
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63121-2917
Practice Address - Country:US
Practice Address - Phone:314-382-9700
Practice Address - Fax:314-385-2500
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-11
Last Update Date:2007-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO26D0921638163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO588648501Medicaid