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NPI Code Detail

MEDICARE: MAUREEN LISA THOMAS

MEDICARE: MAUREEN LISA 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
1363LF0000XFamily Nurse Practitioner24651SC

General Provider Information

NPI Number : 1780279661
Entity Type Code : Individual
Provider Name (Legal Business Name) : MAUREEN LISA THOMAS
Provider Business Mailing Address
First Line : 1303 38TH AVE N
Second Line :
City : MYRTLE BEACH
State : SC
Zip : 29577-1315
Country : US
Telephone Number : 866-389-2727
Fax Number :
Provider Business Practice Location Address
First Line : 1303 38TH AVE N
Second Line :
City : MYRTLE BEACH
State : SC
Zip : 29577-1315
Country : US
Telephone Number : 866-389-2727
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/03/2021
Last Update Date : 05/20/2026

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Directions to “ MAUREEN LISA THOMAS ” Practice Location

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