Provider Demographics
NPI:1336684778
Name:THOMAS, NEENA CHALAKKAL (MSN, FNP-BC)
Entity type:Individual
Prefix:
First Name:NEENA
Middle Name:CHALAKKAL
Last Name:THOMAS
Suffix:
Gender:F
Credentials:MSN, FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5325 BRODER BLVD
Mailing Address - Street 2:
Mailing Address - City:DUBLIN
Mailing Address - State:CA
Mailing Address - Zip Code:94568-3309
Mailing Address - Country:US
Mailing Address - Phone:925-551-6700
Mailing Address - Fax:925-551-7693
Practice Address - Street 1:5325 BRODER BLVD
Practice Address - Street 2:
Practice Address - City:DUBLIN
Practice Address - State:CA
Practice Address - Zip Code:94568-3309
Practice Address - Country:US
Practice Address - Phone:925-551-6700
Practice Address - Fax:925-551-7693
Is Sole Proprietor?:No
Enumeration Date:2016-12-20
Last Update Date:2020-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA651936163WE0003X
CANP95005440363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163WE0003XNursing Service ProvidersRegistered NurseEmergency