Provider Demographics
NPI:1821753336
Name:THOMAS, LANEASHA (RN)
Entity Type:Individual
Prefix:
First Name:LANEASHA
Middle Name:
Last Name:THOMAS
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:LANEASHA
Other - Middle Name:
Other - Last Name:ANDERSON
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:11361 N 99TH AVE STE 400&402
Mailing Address - Street 2:
Mailing Address - City:PEORIA
Mailing Address - State:AZ
Mailing Address - Zip Code:85345-5470
Mailing Address - Country:US
Mailing Address - Phone:602-650-1212
Mailing Address - Fax:623-972-6173
Practice Address - Street 1:11361 N 99TH AVE STE 400&402
Practice Address - Street 2:
Practice Address - City:PEORIA
Practice Address - State:AZ
Practice Address - Zip Code:85345-5470
Practice Address - Country:US
Practice Address - Phone:602-650-1212
Practice Address - Fax:623-972-6173
Is Sole Proprietor?:No
Enumeration Date:2021-11-01
Last Update Date:2021-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ265780163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse