Provider Demographics
NPI:1861146318
Name:THOMAS, DEJAVAUGHN (RN)
Entity type:Individual
Prefix:
First Name:DEJAVAUGHN
Middle Name:
Last Name:THOMAS
Suffix:
Gender:M
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3714 PARVISS ST
Mailing Address - Street 2:
Mailing Address - City:PITTSBURGH
Mailing Address - State:PA
Mailing Address - Zip Code:15212-1944
Mailing Address - Country:US
Mailing Address - Phone:412-636-7441
Mailing Address - Fax:
Practice Address - Street 1:3714 PARVISS ST
Practice Address - Street 2:
Practice Address - City:PITTSBURGH
Practice Address - State:PA
Practice Address - Zip Code:15212-1944
Practice Address - Country:US
Practice Address - Phone:412-636-7441
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-02-03
Last Update Date:2022-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARN710172163WG0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WG0000XNursing Service ProvidersRegistered NurseGeneral Practice