Provider Demographics
NPI:1659636934
Name:THOMAS, NICOLE-BERNICE MARIA
Entity Type:Individual
Prefix:MS
First Name:NICOLE-BERNICE
Middle Name:MARIA
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 1:8139 PENNINGTON DR
Mailing Address - Street 2:
Mailing Address - City:LAUREL
Mailing Address - State:MD
Mailing Address - Zip Code:20724-6120
Mailing Address - Country:US
Mailing Address - Phone:202-705-2474
Mailing Address - Fax:202-291-7018
Practice Address - Street 1:8139 PENNINGTON DR
Practice Address - Street 2:
Practice Address - City:LAUREL
Practice Address - State:MD
Practice Address - Zip Code:20724-6120
Practice Address - Country:US
Practice Address - Phone:202-705-2474
Practice Address - Fax:202-291-7018
Is Sole Proprietor?:Yes
Enumeration Date:2012-07-12
Last Update Date:2012-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCRN 42355163WC0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WC0400XNursing Service ProvidersRegistered NurseCase Management
Provider Identifiers
StateIdentifier IDID TypeIssuer
DCRN42355OtherDISTRICT OF COLUMBA BOARD OF NURSING