Provider Demographics
NPI:1215504238
Name:THOMAS, MABEL A (CRNP)
Entity type:Individual
Prefix:
First Name:MABEL
Middle Name:A
Last Name:THOMAS
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:555 S 43RD ST
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19104-4408
Mailing Address - Country:US
Mailing Address - Phone:215-970-4588
Mailing Address - Fax:
Practice Address - Street 1:555 S 43RD ST
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19104-4408
Practice Address - Country:US
Practice Address - Phone:215-685-7522
Practice Address - Fax:215-685-6848
Is Sole Proprietor?:No
Enumeration Date:2021-06-08
Last Update Date:2023-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASP022271363LG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1952589236Medicaid