Healthcare Provider Details

I. General information

NPI: 1972899953
Provider Name (Legal Business Name): CHERYL M THOMAS R.N.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/28/2011
Last Update Date: 02/08/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4970 BELMONT AVE
YOUNGSTOWN OH
44505-1018
US

IV. Provider business mailing address

420 YOUNGSTOWN POLAND RD
STRUTHERS OH
44471-1058
US

V. Phone/Fax

Practice location:
  • Phone: 330-759-8237
  • Fax: 330-759-9532
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WP0809X
TaxonomyAdult Psychiatric/Mental Health Registered Nurse
License NumberRN 213836
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: