Provider Demographics
NPI:1790592053
Name:THOMAS, RICHARD EUGENE (RN)
Entity type:Individual
Prefix:
First Name:RICHARD
Middle Name:EUGENE
Last Name:THOMAS
Suffix:
Gender:M
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:183 MEADOW FARM S
Mailing Address - Street 2:
Mailing Address - City:NORTH CHILI
Mailing Address - State:NY
Mailing Address - Zip Code:14514-1312
Mailing Address - Country:US
Mailing Address - Phone:585-353-2232
Mailing Address - Fax:
Practice Address - Street 1:183 MEADOW FARM S
Practice Address - Street 2:
Practice Address - City:NORTH CHILI
Practice Address - State:NY
Practice Address - Zip Code:14514-1312
Practice Address - Country:US
Practice Address - Phone:585-353-2232
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-12-11
Last Update Date:2024-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY751855163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse