Provider Demographics
NPI:1215513080
Name:WASHINGTON, THOMBELINA (BSN,RN, PHN)
Entity type:Individual
Prefix:
First Name:THOMBELINA
Middle Name:
Last Name:WASHINGTON
Suffix:
Gender:F
Credentials:BSN,RN, PHN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6926 PLYMOUTH RD
Mailing Address - Street 2:
Mailing Address - City:STOCKTON
Mailing Address - State:CA
Mailing Address - Zip Code:95207-2314
Mailing Address - Country:US
Mailing Address - Phone:209-688-8541
Mailing Address - Fax:209-458-6606
Practice Address - Street 1:6926 PLYMOUTH RD
Practice Address - Street 2:
Practice Address - City:STOCKTON
Practice Address - State:CA
Practice Address - Zip Code:95207-2314
Practice Address - Country:US
Practice Address - Phone:209-688-8541
Practice Address - Fax:209-458-6606
Is Sole Proprietor?:No
Enumeration Date:2021-03-22
Last Update Date:2021-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95213141163WH0200X, 163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
No163WH0200XNursing Service ProvidersRegistered NurseHome Health