MEDICARE: MRS. NANCY THOMAS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	390200000X	Student in an Organized Health Care Education/Training Program

General Provider Information

NPI Number	:	1447453303
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. NANCY THOMAS

Provider Business Mailing Address
First Line	:	73 MORAINE ST
Second Line	:
City	:	BROCKTON
State	:	MA
Zip	:	02301-3109
Country	:	US
Telephone Number	:	508-586-7003
Fax Number	:

Provider Business Practice Location Address
First Line	:	1115 W CHESTNUT ST
Second Line	:
City	:	BROCKTON
State	:	MA
Zip	:	02301-7501
Country	:	US
Telephone Number	:	508-559-0473
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/07/2007
Last Update Date	:	07/08/2007

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