Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LA2100X | Nurse Practitioner - Acute Care | 1-135418 | AL |
N | 363LG0600X | Nurse Practitioner - Gerontology | 1-135418 | AL |
NPI | 1073058251 |
---|---|
Provider Name | Mr. Evan Earl Thomas |
First Address | Birmingham, AL 35206-1829 |
Second Address | Birmingham, AL 35205-3423 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 27/12/2016 |
Last Update Date | 27/12/2016 |