Healthcare Provider Details

I. General information

NPI: 1386056711
Provider Name (Legal Business Name): WENDY THOMAS FNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/20/2014
Last Update Date: 11/02/2023
Certification Date: 11/02/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20 OHLTOWN RD
YOUNGSTOWN OH
44515-2331
US

IV. Provider business mailing address

20 OHLTOWN RD
YOUNGSTOWN OH
44515-2331
US

V. Phone/Fax

Practice location:
  • Phone: 330-884-1500
  • Fax: 330-941-3186
Mailing address:
  • Phone: 330-941-3489
  • Fax: 330-884-1500

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number023756
License Number StateOH
# 2
Primary TaxonomyY
Taxonomy Code364SA2200X
TaxonomyAdult Health Clinical Nurse Specialist
License Number2012006272
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: