Provider Demographics
NPI:1477113579
Name:THOMAS, PHYLICIA (LPN)
Entity Type:Individual
Prefix:MS
First Name:PHYLICIA
Middle Name:
Last Name:THOMAS
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1545 WIGWAM PKWY APT 922
Mailing Address - Street 2:
Mailing Address - City:HENDERSON
Mailing Address - State:NV
Mailing Address - Zip Code:89074-8274
Mailing Address - Country:US
Mailing Address - Phone:708-261-6627
Mailing Address - Fax:
Practice Address - Street 1:1545 WIGWAM PKWY APT 922
Practice Address - Street 2:
Practice Address - City:HENDERSON
Practice Address - State:NV
Practice Address - Zip Code:89074-8274
Practice Address - Country:US
Practice Address - Phone:708-261-6627
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-06-19
Last Update Date:2019-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV814715164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse