Basic Information
| Provider Information | |||||||||
| NPI: | 1083819296 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | THOMAS | ||||||||
| FirstName: | VIRGINIA | ||||||||
| MiddleName: | R | ||||||||
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| Credential: | PA-C | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1499 W 120TH AVE | ||||||||
| Address2: | SUITE 230 | ||||||||
| City: | WESTMINSTER | ||||||||
| State: | CO | ||||||||
| PostalCode: | 802342751 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3039205161 | ||||||||
| FaxNumber: | 3034524625 | ||||||||
| Practice Location | |||||||||
| Address1: | 1499 W 120TH AVE | ||||||||
| Address2: | SUITE 230 | ||||||||
| City: | WESTMINSTER | ||||||||
| State: | CO | ||||||||
| PostalCode: | 802342751 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3039205161 | ||||||||
| FaxNumber: | 3034524625 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/18/2007 | ||||||||
| LastUpdateDate: | 12/03/2010 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 164W00000X | 27368 | CO | N | Nursing Service Providers | Licensed Practical Nurse | 363AM0700X | 2895 | CO | Y | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant | Medical |
No ID Information.