Provider Demographics
NPI:1578730529
Name:THOM, SHENDRY ANYA (MSN, APRN, FNP)
Entity Type:Individual
Prefix:MRS
First Name:SHENDRY
Middle Name:ANYA
Last Name:THOM
Suffix:
Gender:F
Credentials:MSN, APRN, FNP
Other - Prefix:
Other - First Name:SHENDRY
Other - Middle Name:
Other - Last Name:RUSERT
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:APRN
Mailing Address - Street 1:18045 MARANGO RD
Mailing Address - Street 2:
Mailing Address - City:RENO
Mailing Address - State:NV
Mailing Address - Zip Code:89521-8828
Mailing Address - Country:US
Mailing Address - Phone:775-685-0946
Mailing Address - Fax:
Practice Address - Street 1:55 DAMONTE RANCH PKWY
Practice Address - Street 2:
Practice Address - City:RENO
Practice Address - State:NV
Practice Address - Zip Code:89521-2996
Practice Address - Country:US
Practice Address - Phone:775-852-9300
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-05-09
Last Update Date:2015-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVRN52066163W00000X
NVAPN001069363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV004716904Medicaid