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General NPI Number Information
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NPI Number | 1528158474
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Entity Type | Individual
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Provider Name | MICHELE R. THOMAZIN RN, FNP-C
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Gender | Female
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Dates
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Enumeration Date | 10/13/2006
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Last Update Date | 09/09/2015
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Provider Practice Location Address
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Address Line | 1317 W BROADWAY ST
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City | BOLIVAR
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State | MO
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Zip | 65613-1814
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Country | US
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Telephone | 417-326-7250
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Fax | 417-326-2766
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Provider Business Mailing Address
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Address Line | 1317 W BROADWAY ST
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City | BOLIVAR
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State | MO
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Zip | 65613-1814
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Country | US
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Telephone | 417-326-7250
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Fax | 417-326-2766
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number | 131629
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License Number State | MO
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