Provider Demographics
NPI:1528293644
Name:THOMAS, PHYLLIS ELAINE (WHNPC)
Entity type:Individual
Prefix:MRS
First Name:PHYLLIS
Middle Name:ELAINE
Last Name:THOMAS
Suffix:
Gender:F
Credentials:WHNPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11 POST OAK COURT
Mailing Address - Street 2:
Mailing Address - City:HAMPTON
Mailing Address - State:VA
Mailing Address - Zip Code:23666
Mailing Address - Country:US
Mailing Address - Phone:757-596-6369
Mailing Address - Fax:
Practice Address - Street 1:12420 WARWICK BLVD
Practice Address - Street 2:BUILDING 5
Practice Address - City:NEWPORT NEWS
Practice Address - State:VA
Practice Address - Zip Code:23606-3001
Practice Address - Country:US
Practice Address - Phone:757-596-6369
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-05-19
Last Update Date:2009-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0001142737163W00000X
VA0024142737163WW0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WW0101XNursing Service ProvidersRegistered NurseWomen's Health Care, Ambulatory
No163W00000XNursing Service ProvidersRegistered Nurse