Provider Demographics
NPI:1336224815
Name:THOMAS, HERMAN LEE JR (RN)
Entity Type:Individual
Prefix:MR
First Name:HERMAN
Middle Name:LEE
Last Name:THOMAS
Suffix:JR
Gender:M
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 92
Mailing Address - Street 2:
Mailing Address - City:VERNON HILL
Mailing Address - State:VA
Mailing Address - Zip Code:24597-0092
Mailing Address - Country:US
Mailing Address - Phone:434-476-2256
Mailing Address - Fax:
Practice Address - Street 1:2129 OAK LEVEL RD
Practice Address - Street 2:
Practice Address - City:HALIFAX
Practice Address - State:VA
Practice Address - Zip Code:24558
Practice Address - Country:US
Practice Address - Phone:434-476-2256
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0001175455163WC0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WC0200XNursing Service ProvidersRegistered NurseCritical Care Medicine