Provider Demographics
NPI:1255045498
Name:THOMAS, MICHELLE LYNN
Entity type:Individual
Prefix:PROF
First Name:MICHELLE
Middle Name:LYNN
Last Name:THOMAS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8142 SHOTTERY TER
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46268-3327
Mailing Address - Country:US
Mailing Address - Phone:317-652-0805
Mailing Address - Fax:
Practice Address - Street 1:8142 SHOTTERY TER
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46268-3327
Practice Address - Country:US
Practice Address - Phone:317-652-0805
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-01-12
Last Update Date:2023-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN220158531251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health