MEDICARE: LAWANDA MICHELLE 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	372600000X	Adult Companion

General Provider Information

NPI Number	:	1558909804
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LAWANDA MICHELLE THOMAS

Provider Business Mailing Address
First Line	:	4301 23RD PKWY APT 213
Second Line	:
City	:	TEMPLE HILLS
State	:	MD
Zip	:	20748-4449
Country	:	US
Telephone Number	:	240-291-3692
Fax Number	:

Provider Business Practice Location Address
First Line	:	4301 23RD PKWY APT 213
Second Line	:
City	:	TEMPLE HILLS
State	:	MD
Zip	:	20748-4449
Country	:	US
Telephone Number	:	240-219-3692
Fax Number	:

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

Provider Enumeration Date	:	12/17/2019
Last Update Date	:	12/17/2019

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