Provider Demographics
NPI:1558629246
Name:PAINE, THELMA E (APRN)
Entity Type:Individual
Prefix:
First Name:THELMA
Middle Name:E
Last Name:PAINE
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:913 SOUTHERLY RD APT 205
Mailing Address - Street 2:
Mailing Address - City:TOWSON
Mailing Address - State:MD
Mailing Address - Zip Code:21204-2621
Mailing Address - Country:US
Mailing Address - Phone:419-280-0962
Mailing Address - Fax:
Practice Address - Street 1:22 W PADONIA RD
Practice Address - Street 2:
Practice Address - City:LUTHERVILLE TIMONIUM
Practice Address - State:MD
Practice Address - Zip Code:21093-2226
Practice Address - Country:US
Practice Address - Phone:419-280-0962
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-05-01
Last Update Date:2021-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH377629163W00000X
OHCNP024225363LF0000X
MDR241784163W00000X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse