Provider Demographics
NPI:1346345329
Name:NAMAYA, THOM (FNP DSC)
Entity Type:Individual
Prefix:DR
First Name:THOM
Middle Name:
Last Name:NAMAYA
Suffix:
Gender:M
Credentials:FNP DSC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:773 GUILFORD ST
Mailing Address - Street 2:
Mailing Address - City:BRATTLEBORO
Mailing Address - State:VT
Mailing Address - Zip Code:05301
Mailing Address - Country:US
Mailing Address - Phone:802-254-4765
Mailing Address - Fax:802-254-1092
Practice Address - Street 1:773 GUILFORD ST
Practice Address - Street 2:
Practice Address - City:BRATTLEBORO
Practice Address - State:VT
Practice Address - Zip Code:05301
Practice Address - Country:US
Practice Address - Phone:802-254-4765
Practice Address - Fax:802-254-1092
Is Sole Proprietor?:No
Enumeration Date:2006-09-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT1010022347363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
VT0NP0772Medicaid
29578OtherBCBS
29578OtherBCBS
VT0NP0772Medicaid