Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LW0102X | Nurse Practitioner - Women's Health | SP020701 | PA |
NPI | 1073154308 |
---|---|
Provider Name | Nicole Lea Thomas |
First Address | York, PA 17403-2862 |
Second Address | York, PA 17408-6344 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 08/10/2019 |
Last Update Date | 11/03/2021 |