Healthcare Provider Details

I. General information

NPI: 1770401267
Provider Name (Legal Business Name): NATALIE RENEE THOMAS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/09/2026
Last Update Date: 07/09/2026
Certification Date: 07/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

28903 WOODWARD AVE
BERKLEY MI
48072-0924
US

IV. Provider business mailing address

8187 DOWNING ST
WASHINGTON TOWNSHIP MI
48094-3967
US

V. Phone/Fax

Practice location:
  • Phone: 248-581-0333
  • Fax:
Mailing address:
  • Phone: 586-382-0095
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number4704353158
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: