Provider Demographics
NPI:1679371595
Name:THOMAS, STACIE L
Entity type:Individual
Prefix:
First Name:STACIE
Middle Name:L
Last Name:THOMAS
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3205 MAPLEWOOD BLVD APT 9
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68134-5441
Mailing Address - Country:US
Mailing Address - Phone:531-225-4223
Mailing Address - Fax:
Practice Address - Street 1:3205 MAPLEWOOD BLVD APT 9
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68134-5441
Practice Address - Country:US
Practice Address - Phone:531-225-4223
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-03-05
Last Update Date:2025-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE372600000X, 372500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes372500000XNursing Service Related ProvidersChore Provider
No372600000XNursing Service Related ProvidersAdult Companion