=====================================================
General NPI Number Information
=====================================================
NPI Number | 1790429926
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | NEELAM SIDDIQ THOMAS PLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/25/2022
-----------------------------------------------------
Last Update Date | 03/14/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 531 COMMERCIAL ST STE 700
-----------------------------------------------------
City | WATERLOO
-----------------------------------------------------
State | IA
-----------------------------------------------------
Zip | 50701-5443
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 515-209-5009
-----------------------------------------------------
Fax | 319-253-3954
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 531 COMMERCIAL ST STE 700
-----------------------------------------------------
City | WATERLOO
-----------------------------------------------------
State | IA
-----------------------------------------------------
Zip | 50701-5443
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 515-209-5009
-----------------------------------------------------
Fax | 319-540-8059
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | ARNP
-----------------------------------------------------
Name | NEELAM SIDDIQ THOMAS
-----------------------------------------------------
Credential | ARNP
-----------------------------------------------------
Telephone | 515-209-5009
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363LP0808X
-----------------------------------------------------
Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------