Provider Demographics
NPI:1578994117
Name:THOMAS, KAREN THERESA
Entity Type:Individual
Prefix:
First Name:KAREN
Middle Name:THERESA
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 1:109-33 197TH ST
Mailing Address - Street 2:
Mailing Address - City:ST ALBANS
Mailing Address - State:NY
Mailing Address - Zip Code:11412
Mailing Address - Country:US
Mailing Address - Phone:954-381-9268
Mailing Address - Fax:
Practice Address - Street 1:109-33 197TH ST
Practice Address - Street 2:
Practice Address - City:ST ALBANS
Practice Address - State:NY
Practice Address - Zip Code:11412
Practice Address - Country:US
Practice Address - Phone:954-381-9268
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-12-09
Last Update Date:2013-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY311199164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse