Provider Demographics
NPI:1871076760
Name:ANDERSON, THOMASINA DESHEA (REGISTERED NURSE)
Entity type:Individual
Prefix:
First Name:THOMASINA
Middle Name:DESHEA
Last Name:ANDERSON
Suffix:
Gender:F
Credentials:REGISTERED NURSE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1113 VENTURE LN
Mailing Address - Street 2:
Mailing Address - City:DESOTO
Mailing Address - State:TX
Mailing Address - Zip Code:75115-6502
Mailing Address - Country:US
Mailing Address - Phone:972-854-9171
Mailing Address - Fax:
Practice Address - Street 1:1113 VENTURE LN
Practice Address - Street 2:
Practice Address - City:DESOTO
Practice Address - State:TX
Practice Address - Zip Code:75115-6502
Practice Address - Country:US
Practice Address - Phone:972-854-9171
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-09-07
Last Update Date:2018-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX951672163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse