Provider Demographics
NPI:1992139760
Name:THOMAS, ANGELA (LPN)
Entity type:Individual
Prefix:
First Name:ANGELA
Middle Name:
Last Name:THOMAS
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 1:18250 MIDDLEBELT RD
Mailing Address - Street 2:APT 201
Mailing Address - City:LIVONIA
Mailing Address - State:MI
Mailing Address - Zip Code:48152-5004
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:18250 MIDDLEBELT RD
Practice Address - Street 2:APT 201
Practice Address - City:LIVONIA
Practice Address - State:MI
Practice Address - Zip Code:48152-5004
Practice Address - Country:US
Practice Address - Phone:313-208-2989
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-08-28
Last Update Date:2013-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4703090943164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4703090943OtherLPN LICENSE