Provider Demographics
NPI:1194168773
Name:THOMAS, MARCIA MARIE (RN)
Entity type:Individual
Prefix:
First Name:MARCIA
Middle Name:MARIE
Last Name:THOMAS
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:37 W 26TH ST FL 6
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10010-1058
Mailing Address - Country:US
Mailing Address - Phone:212-696-1550
Mailing Address - Fax:212-696-1602
Practice Address - Street 1:37 W 26TH ST FL 6
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10010-1058
Practice Address - Country:US
Practice Address - Phone:212-696-1550
Practice Address - Fax:212-696-1602
Is Sole Proprietor?:No
Enumeration Date:2013-04-12
Last Update Date:2013-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY304970-1163WA2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WA2000XNursing Service ProvidersRegistered NurseAdministrator
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02850677Medicaid