Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LG0600X | Nurse Practitioner - Gerontology | 1-123617 | AL |
NPI | 1043748346 |
---|---|
Provider Name | Jennifer Denise Thomas |
First Address | Mobile, AL 36609-2958 |
Second Address | Mobile, AL 36609-2958 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 31/05/2017 |
Last Update Date | 31/05/2017 |