MEDICARE: MS. VANESSA CYNTHIA THOMAS CRNP

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	363LA2200X	Adult Health Nurse Practitioner	R102907	MD

General Provider Information

NPI Number	:	1639179104
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. VANESSA CYNTHIA THOMAS CRNP

Provider Business Mailing Address
First Line	:	1237 GLENHAVEN RD
Second Line	:
City	:	BALTIMORE
State	:	MD
Zip	:	21239-2238
Country	:	US
Telephone Number	:	410-323-3185
Fax Number	:

Provider Business Practice Location Address
First Line	:	8028 RITCHIE HWY
Second Line	:	STE 210
City	:	PASADENA
State	:	MD
Zip	:	21122-1075
Country	:	US
Telephone Number	:	410-766-1995
Fax Number	:	410-761-6095

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

Provider Enumeration Date	:	07/27/2005
Last Update Date	:	07/08/2007

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