Provider Demographics
NPI:1639379423
Name:THOMAS-PARSON, SAMONE MARIE (LPN)
Entity Type:Individual
Prefix:MRS
First Name:SAMONE
Middle Name:MARIE
Last Name:THOMAS-PARSON
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:176 MITCHELL ST
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14621-3956
Mailing Address - Country:US
Mailing Address - Phone:585-615-1511
Mailing Address - Fax:585-288-0479
Practice Address - Street 1:176 MITCHELL ST
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14621-3956
Practice Address - Country:US
Practice Address - Phone:585-615-1511
Practice Address - Fax:585-288-0479
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-20
Last Update Date:2007-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY270552-1164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02755939Medicaid