Provider Demographics
NPI:1740689074
Name:THOMAS, AMBER (RN, BSN, IBCLC, LCCE)
Entity type:Individual
Prefix:
First Name:AMBER
Middle Name:
Last Name:THOMAS
Suffix:
Gender:F
Credentials:RN, BSN, IBCLC, LCCE
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 12113
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75225-0113
Mailing Address - Country:US
Mailing Address - Phone:940-453-7479
Mailing Address - Fax:
Practice Address - Street 1:2014 DENTON
Practice Address - Street 2:
Practice Address - City:DENTON
Practice Address - State:TX
Practice Address - Zip Code:76208
Practice Address - Country:US
Practice Address - Phone:940-453-7479
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-08-22
Last Update Date:2015-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX851853163WL0100X
174H00000X, 374J00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WL0100XNursing Service ProvidersRegistered NurseLactation Consultant
No174H00000XOther Service ProvidersHealth Educator
No374J00000XNursing Service Related ProvidersDoula