Provider Demographics
NPI:1609914233
Name:THOMAS, DOLORES DAVENPORT (CRNP)
Entity Type:Individual
Prefix:
First Name:DOLORES
Middle Name:DAVENPORT
Last Name:THOMAS
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5244 KIRKWALL LN
Mailing Address - Street 2:
Mailing Address - City:BIRMINGHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35242-4123
Mailing Address - Country:US
Mailing Address - Phone:205-995-1881
Mailing Address - Fax:
Practice Address - Street 1:890 ODUM RD
Practice Address - Street 2:WAL-MART CHECK UP
Practice Address - City:GARDENDALE
Practice Address - State:AL
Practice Address - Zip Code:35071-4617
Practice Address - Country:US
Practice Address - Phone:205-631-8110
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-03
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1-036117363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL590077Medicare UPIN