Provider Demographics
NPI:1477832905
Name:THOMAS, DIANNE MAY
Entity Type:Individual
Prefix:MRS
First Name:DIANNE
Middle Name:MAY
Last Name:THOMAS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:70 BATESVILLE BLVD STE C
Mailing Address - Street 2:
Mailing Address - City:BATESVILLE
Mailing Address - State:AR
Mailing Address - Zip Code:72501-8972
Mailing Address - Country:US
Mailing Address - Phone:870-288-0009
Mailing Address - Fax:
Practice Address - Street 1:70 BATESVILLE BLVD STE C
Practice Address - Street 2:
Practice Address - City:BATESVILLE
Practice Address - State:AR
Practice Address - Zip Code:72501-8972
Practice Address - Country:US
Practice Address - Phone:870-288-0009
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-08-15
Last Update Date:2011-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator