Provider Demographics
NPI:1841713401
Name:THOMAS, DEVAN MICHAEL (NURSE PRACTITIONER)
Entity type:Individual
Prefix:
First Name:DEVAN
Middle Name:MICHAEL
Last Name:THOMAS
Suffix:
Gender:M
Credentials:NURSE PRACTITIONER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:75 S 200 E
Mailing Address - Street 2:STE 100
Mailing Address - City:PROVO
Mailing Address - State:UT
Mailing Address - Zip Code:84606-3146
Mailing Address - Country:US
Mailing Address - Phone:801-877-5801
Mailing Address - Fax:
Practice Address - Street 1:10011 S CENTENNIAL PKWY STE 350
Practice Address - Street 2:
Practice Address - City:SANDY
Practice Address - State:UT
Practice Address - Zip Code:84070-4137
Practice Address - Country:US
Practice Address - Phone:801-566-5350
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-07-25
Last Update Date:2020-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT86565854405363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily