Provider Demographics
NPI:1255683926
Name:THOMAS, TERESA LYNNETTE (MT)
Entity type:Individual
Prefix:
First Name:TERESA
Middle Name:LYNNETTE
Last Name:THOMAS
Suffix:
Gender:F
Credentials:MT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1993 ERRECART BLVD
Mailing Address - Street 2:
Mailing Address - City:ELKO
Mailing Address - State:NV
Mailing Address - Zip Code:89801
Mailing Address - Country:US
Mailing Address - Phone:775-748-4833
Mailing Address - Fax:775-777-8494
Practice Address - Street 1:1993 ERRECART BLVD
Practice Address - Street 2:
Practice Address - City:ELKO
Practice Address - State:NV
Practice Address - Zip Code:89801
Practice Address - Country:US
Practice Address - Phone:775-748-4833
Practice Address - Fax:775-777-8494
Is Sole Proprietor?:No
Enumeration Date:2012-10-05
Last Update Date:2015-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV71442146M00000X
NV3856TGS-2246QM0706X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246QM0706XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, PathologyMedical Technologist
No146M00000XEmergency Medical Service ProvidersEmergency Medical Technician, Intermediate