Provider Demographics
NPI:1821355876
Name:THOMAS, MARCY LYNN (NP)
Entity Type:Individual
Prefix:
First Name:MARCY
Middle Name:LYNN
Last Name:THOMAS
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11333 COUNTY ROAD 2
Mailing Address - Street 2:
Mailing Address - City:MIDDLEBURY
Mailing Address - State:IN
Mailing Address - Zip Code:46540-9632
Mailing Address - Country:US
Mailing Address - Phone:574-825-8000
Mailing Address - Fax:574-260-9580
Practice Address - Street 1:11333 COUNTY ROAD 2
Practice Address - Street 2:
Practice Address - City:MIDDLEBURY
Practice Address - State:IN
Practice Address - Zip Code:46540-9632
Practice Address - Country:US
Practice Address - Phone:574-825-8000
Practice Address - Fax:574-260-9580
Is Sole Proprietor?:No
Enumeration Date:2012-04-16
Last Update Date:2022-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN71003934A363L00000X, 363LX0106X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LX0106XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerOccupational Health