MEDICARE: JUANITA FELISHA THOMAS NURSE AIDE

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	372600000X	Adult Companion
2	372500000X	Chore Provider
3	374U00000X	Home Health Aide
4	376J00000X	Homemaker
5	376K00000X	Nurse's Aide	2004399	MO

General Provider Information

NPI Number	:	1518167246
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JUANITA FELISHA THOMAS NURSE AIDE

Provider Business Mailing Address
First Line	:	8420 SAINT OLAF DR
Second Line	:
City	:	SAINT LOUIS
State	:	MO
Zip	:	63134-1110
Country	:	US
Telephone Number	:	314-824-7476
Fax Number	:

Provider Business Practice Location Address
First Line	:	4144 LINDELL BLVD STE 317
Second Line	:
City	:	SAINT LOUIS
State	:	MO
Zip	:	63108-2953
Country	:	US
Telephone Number	:	314-824-7476
Fax Number	:

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

Provider Enumeration Date	:	07/20/2007
Last Update Date	:	06/27/2014

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