Provider Demographics
NPI:1184171183
Name:THOMAS, PREMILA (FNP)
Entity type:Individual
Prefix:MRS
First Name:PREMILA
Middle Name:
Last Name:THOMAS
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8929 PANAMA RD STE B
Mailing Address - Street 2:
Mailing Address - City:LAMONT
Mailing Address - State:CA
Mailing Address - Zip Code:93241-1647
Mailing Address - Country:US
Mailing Address - Phone:661-489-5999
Mailing Address - Fax:661-489-5991
Practice Address - Street 1:5400 ALDRIN CT
Practice Address - Street 2:
Practice Address - City:BAKERSFIELD
Practice Address - State:CA
Practice Address - Zip Code:93313-2103
Practice Address - Country:US
Practice Address - Phone:661-489-5999
Practice Address - Fax:661-489-5991
Is Sole Proprietor?:Yes
Enumeration Date:2016-09-07
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95006329207Q00000X
CA714074164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA95006329OtherFAMILY NURSE PRACTITIONER