Basic Information
| Provider Information | |||||||||
| NPI: | 1104443613 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | THUO | ||||||||
| FirstName: | JOSEPHINE | ||||||||
| MiddleName: | NDUTA | ||||||||
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| Credential: | NP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1082 DAVOL ST | ||||||||
| Address2: | |||||||||
| City: | FALL RIVER | ||||||||
| State: | MA | ||||||||
| PostalCode: | 027201124 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5086782833 | ||||||||
| FaxNumber: | 5086759460 | ||||||||
| Practice Location | |||||||||
| Address1: | 1082 DAVOL ST | ||||||||
| Address2: | |||||||||
| City: | FALL RIVER | ||||||||
| State: | MA | ||||||||
| PostalCode: | 027201124 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5086782833 | ||||||||
| FaxNumber: | 5086759460 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/30/2020 | ||||||||
| LastUpdateDate: | 02/02/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 02/02/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LP0808X | RN282742 | MA | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Psych/Mental Health |
No ID Information.