Provider Demographics
NPI:1134781156
Name:THOMAS, ARIEL TILISHA (LPN)
Entity type:Individual
Prefix:
First Name:ARIEL
Middle Name:TILISHA
Last Name:THOMAS
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:990 STAFFORD FOREST DR APT 301
Mailing Address - Street 2:
Mailing Address - City:WINSTON SALEM
Mailing Address - State:NC
Mailing Address - Zip Code:27127-6912
Mailing Address - Country:US
Mailing Address - Phone:478-396-1103
Mailing Address - Fax:
Practice Address - Street 1:990 STAFFORD FOREST DR APT 301
Practice Address - Street 2:
Practice Address - City:WINSTON SALEM
Practice Address - State:NC
Practice Address - Zip Code:27127-6912
Practice Address - Country:US
Practice Address - Phone:478-396-1103
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-06-29
Last Update Date:2019-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC85815164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse