Provider Demographics
NPI:1083586366
Name:THOMAS, DESIREE (CBRF TRAINING)
Entity type:Individual
Prefix:
First Name:DESIREE
Middle Name:
Last Name:THOMAS
Suffix:
Gender:F
Credentials:CBRF TRAINING
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:N63W23819 TERRACE DR
Mailing Address - Street 2:
Mailing Address - City:SUSSEX
Mailing Address - State:WI
Mailing Address - Zip Code:53089-3152
Mailing Address - Country:US
Mailing Address - Phone:414-403-0563
Mailing Address - Fax:
Practice Address - Street 1:1538 PACKARD AVE
Practice Address - Street 2:
Practice Address - City:RACINE
Practice Address - State:WI
Practice Address - Zip Code:53403-2147
Practice Address - Country:US
Practice Address - Phone:262-456-0065
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-09-18
Last Update Date:2025-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health