MEDICARE: RHONDA RAESHAWN THOMAS RN

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-349130	OH

General Provider Information

NPI Number	:	1710116371
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	RHONDA RAESHAWN THOMAS RN

Provider Business Mailing Address
First Line	:	21411 RAYMOND ST
Second Line	:
City	:	MAPLE HEIGHTS
State	:	OH
Zip	:	44137-2154
Country	:	US
Telephone Number	:	216-324-8946
Fax Number	:

Provider Business Practice Location Address
First Line	:	21411 RAYMOND ST
Second Line	:
City	:	MAPLE HEIGHTS
State	:	OH
Zip	:	44137-2154
Country	:	US
Telephone Number	:	216-324-8946
Fax Number	:

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

Provider Enumeration Date	:	07/04/2009
Last Update Date	:	07/04/2009

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