Provider Demographics
NPI:1851926638
Name:THOMSON-DIAZ, DEBORAH J (NP-C)
Entity Type:Individual
Prefix:
First Name:DEBORAH
Middle Name:J
Last Name:THOMSON-DIAZ
Suffix:
Gender:F
Credentials:NP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15357 LOVERS LN
Mailing Address - Street 2:
Mailing Address - City:EXCELSIOR SPRINGS
Mailing Address - State:MO
Mailing Address - Zip Code:64024-8517
Mailing Address - Country:US
Mailing Address - Phone:816-560-2474
Mailing Address - Fax:
Practice Address - Street 1:15357 LOVERS LN
Practice Address - Street 2:
Practice Address - City:EXCELSIOR SPRINGS
Practice Address - State:MO
Practice Address - Zip Code:64024-8517
Practice Address - Country:US
Practice Address - Phone:816-560-2474
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-03-11
Last Update Date:2020-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2019012553363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute CareGroup - Single Specialty