Healthcare Provider Details

I. General information

NPI: 1003012287
Provider Name (Legal Business Name): BRENDA THOMASON APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/25/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3510 MAGNOLIA CV
MONROE LA
71203-2372
US

IV. Provider business mailing address

3801 DEBORAH DR
MONROE LA
71201-2111
US

V. Phone/Fax

Practice location:
  • Phone: 318-323-1100
  • Fax: 318-323-1161
Mailing address:
  • Phone: 318-323-5688
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License Number
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: