MEDICARE: TASHA MAE THOMAS BSN, RN

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	163W00000X	Registered Nurse	397245	OH

General Provider Information

NPI Number	:	1134992423
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TASHA MAE THOMAS BSN, RN

Provider Business Mailing Address
First Line	:	4380 PEN RD NW
Second Line	:
City	:	JUNCTION CITY
State	:	OH
Zip	:	43748-9762
Country	:	US
Telephone Number	:	740-215-5231
Fax Number	:

Provider Business Practice Location Address
First Line	:	4380 PEN RD NW
Second Line	:
City	:	JUNCTION CITY
State	:	OH
Zip	:	43748-9762
Country	:	US
Telephone Number	:	740-215-5231
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/30/2023
Last Update Date	:	10/30/2023

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