Provider Demographics
NPI:1780279661
Name:THOMAS, MAUREEN LISA
Entity type:Individual
Prefix:
First Name:MAUREEN
Middle Name:LISA
Last Name:THOMAS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:MAUREEN
Other - Middle Name:LISA
Other - Last Name:SCOTT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:10317 OCEAN HWY # 17S
Mailing Address - Street 2:
Mailing Address - City:PAWLEYS ISLAND
Mailing Address - State:SC
Mailing Address - Zip Code:29585-6520
Mailing Address - Country:US
Mailing Address - Phone:843-223-7403
Mailing Address - Fax:
Practice Address - Street 1:10317 OCEAN HWY # 17S
Practice Address - Street 2:
Practice Address - City:PAWLEYS ISLAND
Practice Address - State:SC
Practice Address - Zip Code:29585-6520
Practice Address - Country:US
Practice Address - Phone:843-237-4036
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-03-03
Last Update Date:2021-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC24651363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily