Individual
ANGEL DESHAWN THOMAS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
FNP-BC
Contact information
Practice address
6928 CHERBOURG DR, FORT WAYNE, IN 46835-9364
(260) 919-5072
Mailing address
6928 CHERBOURG DR, FORT WAYNE, IN 46835-9364
(260) 919-5072
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
28224831A
IN
363LF0000X
Family Nurse Practitioner
Primary
71011732A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
ISA127A9374S
ANTHEM
IN
Enumeration date
09/09/2021
Last updated
11/10/2021
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