MEDICARE: MARYANN DAWN THOMAS ARNP

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	363LF0000X	Family Nurse Practitioner	APRN-LIC-261868	MT
2	363LF0000X	Family Nurse Practitioner	5017280	NC
3	363LF0000X	Family Nurse Practitioner	AC006384	MD
4	363LF0000X	Family Nurse Practitioner	AP60578104	WA
5	363LF0000X	Family Nurse Practitioner	886233	NV
6	363LF0000X	Family Nurse Practitioner	79969	NM
7	363LF0000X	Family Nurse Practitioner	322468	AZ
8	363LF0000X	Family Nurse Practitioner	5371655	ID
9	363LF0000X	Family Nurse Practitioner	95024943	CA
10	363LF0000X	Family Nurse Practitioner	234076	AK
11	363LF0000X	Family Nurse Practitioner	C-APN.0103976	CO
12	363LF0000X	Family Nurse Practitioner	APRN-5146	HI
13	363L00000X	Nurse Practitioner	1098426	TX
14	363LF0000X	Family Nurse Practitioner	10039355	OR
15	363LF0000X	Family Nurse Practitioner	APRN11024135	FL

General Provider Information

NPI Number	:	1588048086
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARYANN DAWN THOMAS ARNP

Provider Business Mailing Address
First Line	:	632 BROADWAY PH 12
Second Line	:
City	:	NEW YORK
State	:	NY
Zip	:	10012-2614
Country	:	US
Telephone Number	:	347-294-3414
Fax Number	:

Provider Business Practice Location Address
First Line	:	1 HAWTHORNE ST UNIT 23D
Second Line	:
City	:	SAN FRANCISCO
State	:	CA
Zip	:	94105-3984
Country	:	US
Telephone Number	:	347-943-8131
Fax Number	:

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

Provider Enumeration Date	:	07/14/2015
Last Update Date	:	09/05/2025

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