Provider Demographics
NPI:1730484155
Name:THOMAS, PAM EILEEN (DAC, LAC)
Entity Type:Individual
Prefix:
First Name:PAM
Middle Name:EILEEN
Last Name:THOMAS
Suffix:
Gender:F
Credentials:DAC, LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:901 HARBOR CIR
Mailing Address - Street 2:
Mailing Address - City:ANCHORAGE
Mailing Address - State:AK
Mailing Address - Zip Code:99515-3672
Mailing Address - Country:US
Mailing Address - Phone:571-242-8136
Mailing Address - Fax:
Practice Address - Street 1:901 HARBOR CIR
Practice Address - Street 2:
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99515-3672
Practice Address - Country:US
Practice Address - Phone:571-242-8136
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-01-14
Last Update Date:2023-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO0001949171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist