1568979292 NPI number — MRS. SANTANNA MARIE THOMAS CRNP

Table of content: MRS. SANTANNA MARIE THOMAS CRNP (NPI 1568979292)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1568979292 NPI number — MRS. SANTANNA MARIE THOMAS CRNP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
THOMAS
Provider First Name:
SANTANNA
Provider Middle Name:
MARIE
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
CRNP
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1568979292
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
06/29/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
545 ELDER ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
IRONDALE
Provider Business Mailing Address State Name:
AL
Provider Business Mailing Address Postal Code:
35210-3303
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
256-603-7136
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2807 GREYSTONE COMMERCIAL BLVD
Provider Second Line Business Practice Location Address:
UNIT 38
Provider Business Practice Location Address City Name:
BIRMINGHAM
Provider Business Practice Location Address State Name:
AL
Provider Business Practice Location Address Postal Code:
35242-9601
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
205-995-1009
Provider Business Practice Location Address Fax Number:
205-995-1049
Provider Enumeration Date:
01/03/2018

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 363LW0102X , with the licence number:  1-148355 , registered in the state of AL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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