Provider Demographics
NPI:1134533599
Name:THOMAS, NICOLE C (ARNP)
Entity type:Individual
Prefix:MRS
First Name:NICOLE
Middle Name:C
Last Name:THOMAS
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 509
Mailing Address - Street 2:
Mailing Address - City:LE MARS
Mailing Address - State:IA
Mailing Address - Zip Code:51031-0509
Mailing Address - Country:US
Mailing Address - Phone:712-541-6620
Mailing Address - Fax:855-344-1082
Practice Address - Street 1:16507 MAHOGANY AVE
Practice Address - Street 2:
Practice Address - City:LE MARS
Practice Address - State:IA
Practice Address - Zip Code:51031-8761
Practice Address - Country:US
Practice Address - Phone:712-541-6620
Practice Address - Fax:855-344-1082
Is Sole Proprietor?:Yes
Enumeration Date:2014-06-13
Last Update Date:2022-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IAG128988363LP0808X, 163WP0809X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WP0809XNursing Service ProvidersRegistered NursePsychiatric/Mental Health, Adult
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health