Provider Demographics
NPI:1770180390
Name:THOMAS, DEMETRIA ABDUALYNN
Entity Type:Individual
Prefix:
First Name:DEMETRIA
Middle Name:ABDUALYNN
Last Name:THOMAS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:199 SKIPPER DR
Mailing Address - Street 2:
Mailing Address - City:MANDEVILLE
Mailing Address - State:LA
Mailing Address - Zip Code:70471-3021
Mailing Address - Country:US
Mailing Address - Phone:504-442-3949
Mailing Address - Fax:
Practice Address - Street 1:199 SKIPPER DR
Practice Address - Street 2:
Practice Address - City:MANDEVILLE
Practice Address - State:LA
Practice Address - Zip Code:70471-3021
Practice Address - Country:US
Practice Address - Phone:504-442-3949
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-10-06
Last Update Date:2020-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA3747P1801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA251E00000XOtherHOME HEALTH