Provider Demographics
NPI:1669642047
Name:WARD-THOMAS, ROXANNE P (RN)
Entity Type:Individual
Prefix:MRS
First Name:ROXANNE
Middle Name:P
Last Name:WARD-THOMAS
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4 SUNSHINE LN
Mailing Address - Street 2:
Mailing Address - City:AMITYVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:11701-1625
Mailing Address - Country:US
Mailing Address - Phone:631-842-1497
Mailing Address - Fax:
Practice Address - Street 1:4 SUNSHINE LN
Practice Address - Street 2:
Practice Address - City:AMITYVILLE
Practice Address - State:NY
Practice Address - Zip Code:11701-1625
Practice Address - Country:US
Practice Address - Phone:631-842-1497
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-03-03
Last Update Date:2008-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY400170-1163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01340656Medicaid