Healthcare Provider Details

I. General information

NPI: 1578755328
Provider Name (Legal Business Name): PRIYA DAISY THOMAS PA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MRS. PRIYA DAISY PHILIP

II. Dates (important events)

Enumeration Date: 08/15/2007
Last Update Date: 12/18/2019
Certification Date: 12/18/2019
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1251 , 334TH STREET WOODWARD RESOURCE CENTER
WOODWARD IA
50276
US

IV. Provider business mailing address

15426 WILDWOOD DRIVE
CLIVE IA
50325
US

V. Phone/Fax

Practice location:
  • Phone: 515-438-3265
  • Fax: 515-438-3631
Mailing address:
  • Phone: 515-438-3265
  • Fax: 515-438-3631

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number001923
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number010623-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: