Provider Demographics
NPI:1689062531
Name:MCPHERSON, THOMAS (RN)
Entity Type:Individual
Prefix:
First Name:THOMAS
Middle Name:
Last Name:MCPHERSON
Suffix:
Gender:M
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8640 COCHISE DR
Mailing Address - Street 2:
Mailing Address - City:HOWARD CITY
Mailing Address - State:MI
Mailing Address - Zip Code:49329-9304
Mailing Address - Country:US
Mailing Address - Phone:616-318-7967
Mailing Address - Fax:
Practice Address - Street 1:8640 COCHISE DR
Practice Address - Street 2:
Practice Address - City:HOWARD CITY
Practice Address - State:MI
Practice Address - Zip Code:49329-9304
Practice Address - Country:US
Practice Address - Phone:616-318-7967
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-12-30
Last Update Date:2014-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704211016171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator