Provider Demographics
NPI:1366131161
Name:THOMAS, MICHELLE LATIA
Entity type:Individual
Prefix:
First Name:MICHELLE
Middle Name:LATIA
Last Name:THOMAS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2307 HARTFORD ST SE APT 2
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20020-7912
Mailing Address - Country:US
Mailing Address - Phone:202-754-1331
Mailing Address - Fax:
Practice Address - Street 1:1516 SHIPPEN LN SE
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20020-2946
Practice Address - Country:US
Practice Address - Phone:202-562-0016
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-05-05
Last Update Date:2023-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant