Provider Demographics
NPI:1851641732
Name:THOMAS, REBECCA U (NP-C)
Entity Type:Individual
Prefix:
First Name:REBECCA
Middle Name:U
Last Name:THOMAS
Suffix:
Gender:F
Credentials:NP-C
Other - Prefix:
Other - First Name:REBECCA
Other - Middle Name:U
Other - Last Name:THOMAS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:NP-C
Mailing Address - Street 1:9809 S REIDAR RD
Mailing Address - Street 2:
Mailing Address - City:LAVEEN
Mailing Address - State:AZ
Mailing Address - Zip Code:85339-7733
Mailing Address - Country:US
Mailing Address - Phone:928-637-3314
Mailing Address - Fax:
Practice Address - Street 1:9809 S REIDAR RD
Practice Address - Street 2:
Practice Address - City:LAVEEN
Practice Address - State:AZ
Practice Address - Zip Code:85339-7733
Practice Address - Country:US
Practice Address - Phone:928-637-3314
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-09-18
Last Update Date:2020-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZAP3060363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily