Healthcare Provider Details

I. General information

NPI: 1053348672
Provider Name (Legal Business Name): DONNA THOMAS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/27/2006
Last Update Date: 07/07/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

610 FAISON DR
COLUMBIA SC
29203-3218
US

IV. Provider business mailing address

P.O. BOX 485
COLUMBIA SC
29202-0485
US

V. Phone/Fax

Practice location:
  • Phone: 803-898-8405
  • Fax:
Mailing address:
  • Phone: 803-898-8405
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License Number49763
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: