Individual
MS. LISIE THOMAS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
NP
Contact information
Practice address
114-02 GUY R BREWER BLVD, JAMAICA, NY 11432-1234
(718) 883-6626
(718) 883-6193
Mailing address
79-01 BROADWAY, D1-01, ELMHURST, NY 11373-1329
(718) 334-1920
(718) 334-5958
Taxonomy
Speciality
Code
Description
License number
State
363LX0001X
Obstetrics & Gynecology Nurse Practitioner
Primary
F420517
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00246075
—
NY
Enumeration date
09/19/2006
Last updated
07/08/2007
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