Provider Demographics
NPI:1720427065
Name:THOMAS, TAMELA MARIE (RN)
Entity Type:Individual
Prefix:
First Name:TAMELA
Middle Name:MARIE
Last Name:THOMAS
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:TAMELA
Other - Middle Name:MARIE
Other - Last Name:GOLDEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:19750 BURT RD
Mailing Address - Street 2:
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48219-2078
Mailing Address - Country:US
Mailing Address - Phone:313-531-2500
Mailing Address - Fax:
Practice Address - Street 1:19601 SAN JOSE BLVD
Practice Address - Street 2:
Practice Address - City:LATHRUP VILLAGE
Practice Address - State:MI
Practice Address - Zip Code:48076-3227
Practice Address - Country:US
Practice Address - Phone:248-392-1250
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-06-20
Last Update Date:2022-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704283469163WP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WP0808XNursing Service ProvidersRegistered NursePsychiatric/Mental Health