Provider Demographics
NPI:1982881116
Name:THOMAS, NICOLE RENEE (LPN)
Entity Type:Individual
Prefix:MS
First Name:NICOLE
Middle Name:RENEE
Last Name:THOMAS
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:MS
Other - First Name:NICOLE
Other - Middle Name:RENEE
Other - Last Name:THOMAS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LPN
Mailing Address - Street 1:145 JACLYN DR
Mailing Address - Street 2:
Mailing Address - City:SYRACUSE
Mailing Address - State:NY
Mailing Address - Zip Code:13205-3259
Mailing Address - Country:US
Mailing Address - Phone:315-751-4674
Mailing Address - Fax:
Practice Address - Street 1:145 JACLYN DR
Practice Address - Street 2:
Practice Address - City:SYRACUSE
Practice Address - State:NY
Practice Address - Zip Code:13205-3259
Practice Address - Country:US
Practice Address - Phone:315-751-4674
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-01-30
Last Update Date:2008-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY270438-1164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse