MEDICARE: JOAN THOMAN MSN RN CDE

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	163WD0400X	Diabetes Educator Registered Nurse	RN157015	OH
2	163WD0400X	Diabetes Educator Registered Nurse	NS02697	OH

General Provider Information

NPI Number	:	1639168131
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JOAN THOMAN MSN RN CDE

Provider Business Mailing Address
First Line	:	6935 TREELINE DR
Second Line	:	STE J
City	:	BRECKSVILLE
State	:	OH
Zip	:	44141-3393
Country	:	US
Telephone Number	:	440-746-2220
Fax Number	:	440-746-3496

Provider Business Practice Location Address
First Line	:	2351 E 22ND ST
Second Line	:
City	:	CLEVELAND
State	:	OH
Zip	:	44115-3111
Country	:	US
Telephone Number	:	216-363-2770
Fax Number	:

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

Provider Enumeration Date	:	10/18/2005
Last Update Date	:	07/08/2007

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