Provider Demographics
NPI:1386247948
Name:THOMAS-PROKASKY, CORAL MAY (LPN)
Entity type:Individual
Prefix:
First Name:CORAL
Middle Name:MAY
Last Name:THOMAS-PROKASKY
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2810 145TH ST W APT 213
Mailing Address - Street 2:
Mailing Address - City:ROSEMOUNT
Mailing Address - State:MN
Mailing Address - Zip Code:55068-4992
Mailing Address - Country:US
Mailing Address - Phone:612-357-2166
Mailing Address - Fax:
Practice Address - Street 1:2810 145TH ST W APT 213
Practice Address - Street 2:
Practice Address - City:ROSEMOUNT
Practice Address - State:MN
Practice Address - Zip Code:55068-4992
Practice Address - Country:US
Practice Address - Phone:612-357-2166
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-11-17
Last Update Date:2020-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN819590164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse