MEDICARE: TOMIKA SHONTAE MCHENRY R.N.

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	RN.343025	OH

General Provider Information

NPI Number	:	1043544026
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TOMIKA SHONTAE MCHENRY R.N.

Provider Business Mailing Address
First Line	:	1825 MANNERING RD
Second Line	:
City	:	CLEVELAND
State	:	OH
Zip	:	44112-1531
Country	:	US
Telephone Number	:	216-571-0134
Fax Number	:	216-486-1249

Provider Business Practice Location Address
First Line	:	1825 MANNERING RD
Second Line	:
City	:	CLEVELAND
State	:	OH
Zip	:	44112-1531
Country	:	US
Telephone Number	:	216-571-0134
Fax Number	:	216-486-1249

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

Provider Enumeration Date	:	09/24/2009
Last Update Date	:	09/24/2009

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