MEDICARE: BRIAN THOMAS RNFA

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	163WR0006X	Registered Nurse First Assistant	51357	WV
2	163WR0006X	Registered Nurse First Assistant	RN.277273-	OH

General Provider Information

NPI Number	:	1730573379
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BRIAN THOMAS RNFA

Provider Business Mailing Address
First Line	:	70542 SWINGLE RD
Second Line	:
City	:	BRIDGEPORT
State	:	OH
Zip	:	43912-9722
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	70542 SWINGLE RD
Second Line	:
City	:	BRIDGEPORT
State	:	OH
Zip	:	43912-9722
Country	:	US
Telephone Number	:	740-635-1877
Fax Number	:

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

Provider Enumeration Date	:	03/21/2015
Last Update Date	:	03/21/2015

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