Provider Demographics
NPI:1841902848
Name:THOMAS, RAVEN (RN)
Entity type:Individual
Prefix:
First Name:RAVEN
Middle Name:
Last Name:THOMAS
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:730 S WEST ST APT B
Mailing Address - Street 2:
Mailing Address - City:BAINBRIDGE
Mailing Address - State:GA
Mailing Address - Zip Code:39819-4592
Mailing Address - Country:US
Mailing Address - Phone:912-536-4772
Mailing Address - Fax:
Practice Address - Street 1:730 S WEST ST APT B
Practice Address - Street 2:
Practice Address - City:BAINBRIDGE
Practice Address - State:GA
Practice Address - Zip Code:39819-4592
Practice Address - Country:US
Practice Address - Phone:912-536-4772
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-12-21
Last Update Date:2022-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
374J00000X
GARN242272163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
No374J00000XNursing Service Related ProvidersDoula