Provider Demographics
NPI:1093559288
Name:THOMAS, KATHERINE (LAC)
Entity type:Individual
Prefix:
First Name:KATHERINE
Middle Name:
Last Name:THOMAS
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3520 BEAVER AVE STE C
Mailing Address - Street 2:
Mailing Address - City:DES MOINES
Mailing Address - State:IA
Mailing Address - Zip Code:50310-3255
Mailing Address - Country:US
Mailing Address - Phone:515-344-4102
Mailing Address - Fax:
Practice Address - Street 1:3520 BEAVER AVE STE C
Practice Address - Street 2:
Practice Address - City:DES MOINES
Practice Address - State:IA
Practice Address - Zip Code:50310-3255
Practice Address - Country:US
Practice Address - Phone:515-344-4102
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-06-21
Last Update Date:2024-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IAA-127171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist