Provider Demographics
NPI:1659962694
Name:THOMAS, MARLENE NICOLE
Entity Type:Individual
Prefix:
First Name:MARLENE
Middle Name:NICOLE
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 1:2111 GOLFSIDE RD # 8
Mailing Address - Street 2:
Mailing Address - City:YPSILANTI
Mailing Address - State:MI
Mailing Address - Zip Code:48197-1145
Mailing Address - Country:US
Mailing Address - Phone:888-759-4917
Mailing Address - Fax:734-547-3014
Practice Address - Street 1:2111 GOLFSIDE RD # 8
Practice Address - Street 2:
Practice Address - City:YPSILANTI
Practice Address - State:MI
Practice Address - Zip Code:48197-1145
Practice Address - Country:US
Practice Address - Phone:888-759-4917
Practice Address - Fax:734-547-3014
Is Sole Proprietor?:Yes
Enumeration Date:2021-02-02
Last Update Date:2021-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171M00000XOther Service ProvidersCase Manager/Care CoordinatorGroup - Single Specialty