MEDICARE: MRS. OLEKACHI JEAN THOMAS IDMT

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	1710I1003X	Independent Duty Medical Technicians

General Provider Information

NPI Number	:	1902037344
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. OLEKACHI JEAN THOMAS IDMT

Provider Business Mailing Address
First Line	:	4700 LAS VEGAS BLVD N
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89191-6600
Country	:	US
Telephone Number	:	702-653-3435
Fax Number	:

Provider Business Practice Location Address
First Line	:	5537 DIANO MARINA CT
Second Line	:
City	:	NORTH LAS VEGAS
State	:	NV
Zip	:	89081-4078
Country	:	US
Telephone Number	:	702-653-3435
Fax Number	:

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

Provider Enumeration Date	:	08/03/2009
Last Update Date	:	01/02/2010

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