Individual
DIANE THOMAS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
NP
Contact information
Practice address
1700 UNIVERSITY AVE W, SAINT PAUL, MN 55104-3727
(651) 232-2202
Mailing address
1700 UNIVERSITY AVE W, SAINT PAUL, MN 55104-3727
(651) 232-2002
Taxonomy
Speciality
Code
Description
License number
State
363LG0600X
Gerontology Nurse Practitioner
Primary
660
MN
363LP2300X
Primary Care Nurse Practitioner
0660
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1609290717
NURSE PRACTITIONER LICENSE 0660
MN
Enumeration date
02/10/2014
Last updated
08/05/2021
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