Healthcare Provider Details

I. General information

NPI: 1982938627
Provider Name (Legal Business Name): JEANINE THOMAS CNM
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/29/2009
Last Update Date: 09/29/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

#82 MOUNT PLEASANT
FREDERICKSTED VI
00840-0000
US

IV. Provider business mailing address

PO BOX 7242
CHRISTIANSTED VI
00823-7242
US

V. Phone/Fax

Practice location:
  • Phone: 340-772-3727
  • Fax: 340-772-3727
Mailing address:
  • Phone: 340-772-3727
  • Fax: 340-772-3727

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367A00000X
TaxonomyAdvanced Practice Midwife
License Number4818
License Number StateVI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: