Provider Demographics
NPI:1205306263
Name:THOMAS, TERESA MESHAWN (LPN)
Entity type:Individual
Prefix:MS
First Name:TERESA
Middle Name:MESHAWN
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 1:3934 E JASPER DR
Mailing Address - Street 2:
Mailing Address - City:GILBERT
Mailing Address - State:AZ
Mailing Address - Zip Code:85296-8255
Mailing Address - Country:US
Mailing Address - Phone:773-495-1515
Mailing Address - Fax:
Practice Address - Street 1:3934 E JASPER DR
Practice Address - Street 2:
Practice Address - City:GILBERT
Practice Address - State:AZ
Practice Address - Zip Code:85296-8255
Practice Address - Country:US
Practice Address - Phone:773-495-1515
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-12-03
Last Update Date:2018-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZLP054634164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse