Individual
MICHELE R. THOMAZIN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
RN, FNP-C
Contact information
Practice address
1317 W BROADWAY ST, BOLIVAR, MO 65613-1814
(417) 326-7250
(417) 326-2766
Mailing address
1317 W BROADWAY ST, BOLIVAR, MO 65613-1814
(417) 326-7250
(417) 326-2766
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
131629
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
200905
BCMO
MO
05
—
427479100
—
MO
Enumeration date
10/13/2006
Last updated
09/09/2015
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