MEDICARE: MRS. LAURIE LYNN THOMAS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	374U00000X	Home Health Aide	514438	VA

General Provider Information

NPI Number	:	1114501749
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. LAURIE LYNN THOMAS

Provider Business Mailing Address
First Line	:	4763 BONNIE BRAE RD
Second Line	:
City	:	NORTH CHESTERFIELD
State	:	VA
Zip	:	23234-3766
Country	:	US
Telephone Number	:	804-840-2018
Fax Number	:

Provider Business Practice Location Address
First Line	:	4763 BONNIE BRAE RD
Second Line	:
City	:	NORTH CHESTERFIELD
State	:	VA
Zip	:	23234-3766
Country	:	US
Telephone Number	:	804-840-2018
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/10/2021
Last Update Date	:	05/10/2021

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