Provider Demographics
NPI:1720409535
Name:ROWE, THOMAS R (FNP-BC)
Entity Type:Individual
Prefix:
First Name:THOMAS
Middle Name:R
Last Name:ROWE
Suffix:
Gender:M
Credentials:FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:108 N FRONTIER ST
Mailing Address - Street 2:N/A
Mailing Address - City:WICKENBURG
Mailing Address - State:AZ
Mailing Address - Zip Code:85390-4411
Mailing Address - Country:US
Mailing Address - Phone:928-684-7255
Mailing Address - Fax:928-684-7299
Practice Address - Street 1:108 N FRONTIER ST
Practice Address - Street 2:N/A
Practice Address - City:WICKENBURG
Practice Address - State:AZ
Practice Address - Zip Code:85390-4411
Practice Address - Country:US
Practice Address - Phone:928-684-7255
Practice Address - Fax:928-684-7299
Is Sole Proprietor?:No
Enumeration Date:2013-12-20
Last Update Date:2013-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZAP5298363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ871348Medicaid