Provider Demographics
NPI:1245424555
Name:THOMAS, THELMA DIANE (CNM)
Entity type:Individual
Prefix:
First Name:THELMA
Middle Name:DIANE
Last Name:THOMAS
Suffix:
Gender:F
Credentials:CNM
Other - Prefix:
Other - First Name:THELMA
Other - Middle Name:DIANE
Other - Last Name:MCLAMB
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CNM
Mailing Address - Street 1:1ST MEDICAL GROUP
Mailing Address - Street 2:77 NEALY AVENUE
Mailing Address - City:LANGLEY AFB
Mailing Address - State:VA
Mailing Address - Zip Code:23665-2023
Mailing Address - Country:US
Mailing Address - Phone:757-764-1043
Mailing Address - Fax:757-764-6843
Practice Address - Street 1:1ST MEDICAL GROUP
Practice Address - Street 2:77 NEALY AVENUE
Practice Address - City:LANGLEY AFB
Practice Address - State:VA
Practice Address - Zip Code:23665-2023
Practice Address - Country:US
Practice Address - Phone:757-764-1043
Practice Address - Fax:757-764-6843
Is Sole Proprietor?:No
Enumeration Date:2007-08-29
Last Update Date:2007-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0024053431367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife