Provider Demographics
NPI:1649002718
Name:ANDRIENNE THOMAS, LLC
Entity type:Organization
Organization Name:ANDRIENNE THOMAS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MS
Authorized Official - First Name:ANDRIENNE
Authorized Official - Middle Name:L
Authorized Official - Last Name:THOMAS
Authorized Official - Suffix:
Authorized Official - Credentials:NP
Authorized Official - Phone:313-409-0399
Mailing Address - Street 1:13003 SANTA CLARA ST
Mailing Address - Street 2:
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48235-1470
Mailing Address - Country:US
Mailing Address - Phone:313-409-0399
Mailing Address - Fax:
Practice Address - Street 1:13003 SANTA CLARA ST
Practice Address - Street 2:
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48235-1470
Practice Address - Country:US
Practice Address - Phone:313-409-0399
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-08-16
Last Update Date:2024-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Multi-Specialty