Healthcare Provider Details

I. General information

NPI: 1538772231
Provider Name (Legal Business Name): TAMARA SUE THOMAS REGISTERED NURSE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/24/2020
Last Update Date: 08/24/2020
Certification Date: 08/24/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1012 ODNR MOHICAN 51
PERRYSVILLE OH
44864-9407
US

IV. Provider business mailing address

394 ALEXANDER RD
BELLVILLE OH
44813-9120
US

V. Phone/Fax

Practice location:
  • Phone: 419-994-0300
  • Fax: 419-994-0305
Mailing address:
  • Phone: 419-544-2221
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN259917
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: