Healthcare Provider Details

I. General information

NPI: 1306355482
Provider Name (Legal Business Name): SIJI MANU THOMAS FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/21/2017
Last Update Date: 04/10/2026
Certification Date: 04/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3592 E MAPLEWOOD ST
GILBERT AZ
85297-7429
US

IV. Provider business mailing address

3592 E MAPLEWOOD ST
GILBERT AZ
85297-7429
US

V. Phone/Fax

Practice location:
  • Phone: 678-620-5287
  • Fax:
Mailing address:
  • Phone: 678-620-5287
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAP10726
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: