Provider Demographics
NPI:1689034480
Name:THOMAS, JEANINE SUSAN (CARE COORDINATOR)
Entity Type:Individual
Prefix:
First Name:JEANINE
Middle Name:SUSAN
Last Name:THOMAS
Suffix:
Gender:F
Credentials:CARE COORDINATOR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 2294
Mailing Address - Street 2:
Mailing Address - City:SOLDOTNA
Mailing Address - State:AK
Mailing Address - Zip Code:99669-2294
Mailing Address - Country:US
Mailing Address - Phone:907-260-1176
Mailing Address - Fax:907-260-1177
Practice Address - Street 1:43961 K BEACH RD
Practice Address - Street 2:
Practice Address - City:SOLDOTNA
Practice Address - State:AK
Practice Address - Zip Code:99669-8276
Practice Address - Country:US
Practice Address - Phone:907-260-1176
Practice Address - Fax:907-260-1177
Is Sole Proprietor?:No
Enumeration Date:2016-03-07
Last Update Date:2016-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator