Provider Demographics
NPI:1306302823
Name:THOMAS, JESSICA ROBIN (NURSE PRACTITIONER)
Entity type:Individual
Prefix:
First Name:JESSICA
Middle Name:ROBIN
Last Name:THOMAS
Suffix:
Gender:F
Credentials:NURSE PRACTITIONER
Other - Prefix:
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Mailing Address - Street 1:1117 S WASHINGTON AVE
Mailing Address - Street 2:
Mailing Address - City:SAGINAW
Mailing Address - State:MI
Mailing Address - Zip Code:48601-2574
Mailing Address - Country:US
Mailing Address - Phone:989-791-4020
Mailing Address - Fax:989-921-8765
Practice Address - Street 1:1117 S WASHINGTON AVE
Practice Address - Street 2:
Practice Address - City:SAGINAW
Practice Address - State:MI
Practice Address - Zip Code:48601-2574
Practice Address - Country:US
Practice Address - Phone:989-791-4020
Practice Address - Fax:989-921-8765
Is Sole Proprietor?:No
Enumeration Date:2019-02-20
Last Update Date:2021-03-30
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MI4704294590208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology