Healthcare Provider Details

I. General information

NPI: 1932036332
Provider Name (Legal Business Name): THOMAS MIK-LUMOR RN
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/07/2026
Last Update Date: 05/07/2026
Certification Date: 05/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

138 BOBBY LN
MANCHESTER CT
06040-6780
US

IV. Provider business mailing address

138 BOBBY LN
MANCHESTER CT
06040-6780
US

V. Phone/Fax

Practice location:
  • Phone: 856-473-8303
  • Fax:
Mailing address:
  • Phone: 856-473-8303
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WM0705X
TaxonomyMedical-Surgical Registered Nurse
License NumberRN2378097
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: