Provider Demographics
NPI:1316177496
Name:LA NORE, THOMAS ALLEN (PA-C)
Entity type:Individual
Prefix:
First Name:THOMAS
Middle Name:ALLEN
Last Name:LA NORE
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3214 GLENSIDE BLVD
Mailing Address - Street 2:
Mailing Address - City:MUSKEGON
Mailing Address - State:MI
Mailing Address - Zip Code:49441-3976
Mailing Address - Country:US
Mailing Address - Phone:231-578-1518
Mailing Address - Fax:
Practice Address - Street 1:3214 GLENSIDE BLVD
Practice Address - Street 2:
Practice Address - City:MUSKEGON
Practice Address - State:MI
Practice Address - Zip Code:49441-3976
Practice Address - Country:US
Practice Address - Phone:231-578-1518
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-07-22
Last Update Date:2009-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5601002938363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant