Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LG0600X | Nurse Practitioner - Gerontology | AG10210137 | MD |
NPI | 1083372577 |
---|---|
Provider Name | Sidya Maelee Thomas |
First Address | Capitol Heights, MD 20743-2825 |
Second Address | Bowie, MD 20716-2604 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 02/12/2021 |
Last Update Date | 02/12/2021 |