Provider Demographics
NPI:1588335061
Name:THOMAS, WILL KEOLA (RN)
Entity type:Individual
Prefix:
First Name:WILL
Middle Name:KEOLA
Last Name:THOMAS
Suffix:
Gender:M
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8737 VENICE BLVD STE 201
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90034-3258
Mailing Address - Country:US
Mailing Address - Phone:510-545-9825
Mailing Address - Fax:
Practice Address - Street 1:8737 VENICE BLVD STE 201
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90034-3258
Practice Address - Country:US
Practice Address - Phone:510-545-9825
Practice Address - Fax:617-491-2070
Is Sole Proprietor?:No
Enumeration Date:2021-09-23
Last Update Date:2021-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95115428163WP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WP0808XNursing Service ProvidersRegistered NursePsychiatric/Mental Health