Provider Demographics
NPI:1053402271
Name:THOMAS, LETA MURLENE (RN)
Entity type:Individual
Prefix:MS
First Name:LETA
Middle Name:MURLENE
Last Name:THOMAS
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7570 W 21ST ST N
Mailing Address - Street 2:SUITE 1026-D
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67205-1734
Mailing Address - Country:US
Mailing Address - Phone:316-729-6555
Mailing Address - Fax:316-634-4794
Practice Address - Street 1:7570 W 21ST ST N
Practice Address - Street 2:SUITE 1026-D
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67205-1734
Practice Address - Country:US
Practice Address - Phone:316-729-6555
Practice Address - Fax:316-634-4794
Is Sole Proprietor?:No
Enumeration Date:2006-09-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS13-31651-102163WP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WP0808XNursing Service ProvidersRegistered NursePsychiatric/Mental Health