Provider Demographics
NPI:1780364760
Name:THOMAS, DANICA
Entity type:Individual
Prefix:
First Name:DANICA
Middle Name:
Last Name:THOMAS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16712 ELM ST
Mailing Address - Street 2:
Mailing Address - City:SOUTH HOLLAND
Mailing Address - State:IL
Mailing Address - Zip Code:60473-2931
Mailing Address - Country:US
Mailing Address - Phone:708-953-9414
Mailing Address - Fax:
Practice Address - Street 1:16712 ELM ST
Practice Address - Street 2:
Practice Address - City:SOUTH HOLLAND
Practice Address - State:IL
Practice Address - Zip Code:60473-2931
Practice Address - Country:US
Practice Address - Phone:708-953-9414
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-07-24
Last Update Date:2023-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171400000XOther Service ProvidersHealth & Wellness Coach
No174N00000XOther Service ProvidersLactation Consultant, Non-RN
No176B00000XOther Service ProvidersMidwife