Provider Demographics
NPI:1891763637
Name:THOMAS, SUSAN DIANE (CRNA)
Entity Type:Individual
Prefix:
First Name:SUSAN
Middle Name:DIANE
Last Name:THOMAS
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:72922 642 AVE
Mailing Address - Street 2:
Mailing Address - City:AUBURN
Mailing Address - State:NE
Mailing Address - Zip Code:68305-8205
Mailing Address - Country:US
Mailing Address - Phone:402-274-7238
Mailing Address - Fax:402-274-4920
Practice Address - Street 1:72922 642 AVE
Practice Address - Street 2:
Practice Address - City:AUBURN
Practice Address - State:NE
Practice Address - Zip Code:68305-8205
Practice Address - Country:US
Practice Address - Phone:402-274-7238
Practice Address - Fax:402-274-4920
Is Sole Proprietor?:No
Enumeration Date:2006-03-09
Last Update Date:2008-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE100567367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE38159OtherBCBS
NE39199966200Medicaid
IA27005OtherBCBS
NE38159OtherBCBS
NE273993Medicare PIN