Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LN0000X | Nurse Practitioner - Neonatal | 3015303 | KY |
NPI | 1013515261 |
---|---|
Provider Name | Wesley Thomas |
First Address | Chicago, IL 60677-6879 |
Second Address | Louisville, KY 40207-4725 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 10/10/2020 |
Last Update Date | 28/01/2021 |