Provider Demographics
NPI:1487884532
Name:THOMAS, RONNIE LEE JR (LPN)
Entity type:Individual
Prefix:MR
First Name:RONNIE
Middle Name:LEE
Last Name:THOMAS
Suffix:JR
Gender:M
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:24 HOBART ST
Mailing Address - Street 2:
Mailing Address - City:BUFFALO
Mailing Address - State:NY
Mailing Address - Zip Code:14206-2921
Mailing Address - Country:US
Mailing Address - Phone:716-444-3984
Mailing Address - Fax:
Practice Address - Street 1:24 HOBART ST
Practice Address - Street 2:
Practice Address - City:BUFFALO
Practice Address - State:NY
Practice Address - Zip Code:14206-2921
Practice Address - Country:US
Practice Address - Phone:716-444-3984
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-07-23
Last Update Date:2009-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY266316-1164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse