Provider Demographics
NPI:1710270228
Name:THOMAS, MILDRED L (REGISTERED NURSE)
Entity Type:Individual
Prefix:MRS
First Name:MILDRED
Middle Name:L
Last Name:THOMAS
Suffix:
Gender:F
Credentials:REGISTERED NURSE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:41 PRINCETON ST
Mailing Address - Street 2:1964
Mailing Address - City:BAY SHORE
Mailing Address - State:NY
Mailing Address - Zip Code:11706-4209
Mailing Address - Country:US
Mailing Address - Phone:631-666-5898
Mailing Address - Fax:631-666-5898
Practice Address - Street 1:41 PRINCETON ST
Practice Address - Street 2:1964
Practice Address - City:BAY SHORE
Practice Address - State:NY
Practice Address - Zip Code:11706-4209
Practice Address - Country:US
Practice Address - Phone:631-666-5898
Practice Address - Fax:631-666-5898
Is Sole Proprietor?:Yes
Enumeration Date:2011-05-17
Last Update Date:2011-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY290596-1163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse