Provider Demographics
NPI:1972808780
Name:THOMAS, SHIRLEY L (LPN)
Entity Type:Individual
Prefix:MRS
First Name:SHIRLEY
Middle Name:L
Last Name:THOMAS
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:SHIRLEY
Other - Middle Name:L
Other - Last Name:COLLINS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:232 SENECA DR
Mailing Address - Street 2:2W
Mailing Address - City:SYRACUSE
Mailing Address - State:NY
Mailing Address - Zip Code:13205-2431
Mailing Address - Country:US
Mailing Address - Phone:315-374-6925
Mailing Address - Fax:
Practice Address - Street 1:232 SENECA DR
Practice Address - Street 2:2W
Practice Address - City:SYRACUSE
Practice Address - State:NY
Practice Address - Zip Code:13205-2431
Practice Address - Country:US
Practice Address - Phone:315-374-6925
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-01-26
Last Update Date:2011-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY304461-1164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse