Provider Demographics
NPI:1821710799
Name:THOMAS, ANDREA (APRN)
Entity Type:Individual
Prefix:
First Name:ANDREA
Middle Name:
Last Name:THOMAS
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1120 N 103RD PLZ
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68114-1114
Mailing Address - Country:US
Mailing Address - Phone:402-354-0400
Mailing Address - Fax:402-354-0425
Practice Address - Street 1:1120 N 103RD PLZ
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68114-1114
Practice Address - Country:US
Practice Address - Phone:402-354-0400
Practice Address - Fax:402-354-0425
Is Sole Proprietor?:Yes
Enumeration Date:2022-09-16
Last Update Date:2022-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE114406363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner