Provider Demographics
NPI:1356679567
Name:THOMAS, MARY Y (APN-C)
Entity Type:Individual
Prefix:MRS
First Name:MARY
Middle Name:Y
Last Name:THOMAS
Suffix:
Gender:F
Credentials:APN-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14 HOME ST
Mailing Address - Street 2:
Mailing Address - City:METUCHEN
Mailing Address - State:NJ
Mailing Address - Zip Code:08840-2409
Mailing Address - Country:US
Mailing Address - Phone:732-603-5014
Mailing Address - Fax:
Practice Address - Street 1:14 HOME ST
Practice Address - Street 2:
Practice Address - City:METUCHEN
Practice Address - State:NJ
Practice Address - Zip Code:08840-2409
Practice Address - Country:US
Practice Address - Phone:732-603-5014
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-11-28
Last Update Date:2009-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NJ00234300363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily