Provider Demographics
NPI:1730681966
Name:THOMAS, KHADIJAH RENEE
Entity type:Individual
Prefix:MRS
First Name:KHADIJAH
Middle Name:RENEE
Last Name:THOMAS
Suffix:
Gender:F
Credentials:
Other - Prefix:MS
Other - First Name:KHADIJAH
Other - Middle Name:RENEE
Other - Last Name:ARMSTRONG
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:G3620 MILLER RD
Mailing Address - Street 2:
Mailing Address - City:FLINT
Mailing Address - State:MI
Mailing Address - Zip Code:48507-1234
Mailing Address - Country:US
Mailing Address - Phone:586-228-9991
Mailing Address - Fax:
Practice Address - Street 1:G3620 MILLER RD
Practice Address - Street 2:
Practice Address - City:FLINT
Practice Address - State:MI
Practice Address - Zip Code:48507-1234
Practice Address - Country:US
Practice Address - Phone:586-228-9991
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-03-04
Last Update Date:2024-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes247200000XTechnologists, Technicians & Other Technical Service ProvidersTechnician, Other