Provider Demographics
NPI:1972128494
Name:VANSANT, THOMAS (RN)
Entity type:Individual
Prefix:
First Name:THOMAS
Middle Name:
Last Name:VANSANT
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 1:114 TALLA QUAW TRL
Mailing Address - Street 2:
Mailing Address - City:CAPITAN
Mailing Address - State:NM
Mailing Address - Zip Code:88316-5034
Mailing Address - Country:US
Mailing Address - Phone:931-408-0015
Mailing Address - Fax:
Practice Address - Street 1:114 TALLA QUAW TRL
Practice Address - Street 2:
Practice Address - City:CAPITAN
Practice Address - State:NM
Practice Address - Zip Code:88316-5034
Practice Address - Country:US
Practice Address - Phone:931-408-0015
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-06-10
Last Update Date:2020-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMRN-77499163WE0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WE0003XNursing Service ProvidersRegistered NurseEmergency