Provider Demographics
NPI:1689660730
Name:THOMAS, CARMEN SIOUX (CRNA)
Entity Type:Individual
Prefix:
First Name:CARMEN
Middle Name:SIOUX
Last Name:THOMAS
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:CARMEN
Other - Middle Name:SIOUX
Other - Last Name:FEE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:CRNA
Mailing Address - Street 1:2080 W ARLINGTON BLVD
Mailing Address - Street 2:SUITE B
Mailing Address - City:GREENVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:27834-3770
Mailing Address - Country:US
Mailing Address - Phone:252-752-2140
Mailing Address - Fax:
Practice Address - Street 1:2825 RANDOLPH RD
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28211-1018
Practice Address - Country:US
Practice Address - Phone:704-337-1647
Practice Address - Fax:704-377-5014
Is Sole Proprietor?:No
Enumeration Date:2005-09-23
Last Update Date:2020-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN170518367500000X
NC164470163W00000X
NC71440367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC1689660730Medicaid
NCQ37230AOtherMEDICARE
GAP00156737OtherRAILROAD MEDICARE