MEDICARE: THERESA THOMAS RN MSN

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	163W00000X	Registered Nurse	131179	NC

General Provider Information

NPI Number	:	1477093086
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	THERESA THOMAS RN MSN

Provider Business Mailing Address
First Line	:	108 SALIX ST
Second Line	:
City	:	CHAPEL HILL
State	:	NC
Zip	:	27516-4667
Country	:	US
Telephone Number	:	919-306-6377
Fax Number	:

Provider Business Practice Location Address
First Line	:	2920 W BROAD ST
Second Line	:	SUITE 218
City	:	RICHMOND
State	:	VA
Zip	:	23230-5103
Country	:	US
Telephone Number	:	919-306-6377
Fax Number	:

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

Provider Enumeration Date	:	03/01/2017
Last Update Date	:	03/01/2017

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