Basic Information
| Provider Information | |||||||||
| NPI: | 1538772231 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | THOMAS | ||||||||
| FirstName: | TAMARA | ||||||||
| MiddleName: | SUE | ||||||||
| NamePrefix: | MRS. | ||||||||
| NameSuffix: | |||||||||
| Credential: | REGISTERED NURSE | ||||||||
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| Mailing Information | |||||||||
| Address1: | 394 ALEXANDER RD | ||||||||
| Address2: | |||||||||
| City: | BELLVILLE | ||||||||
| State: | OH | ||||||||
| PostalCode: | 448139120 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4195442221 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 1012 ODNR MOHICAN 51 | ||||||||
| Address2: | |||||||||
| City: | PERRYSVILLE | ||||||||
| State: | OH | ||||||||
| PostalCode: | 448649407 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4199940300 | ||||||||
| FaxNumber: | 4199940305 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/24/2020 | ||||||||
| LastUpdateDate: | 08/24/2020 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 08/24/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 163W00000X | RN259917 | OH | Y | Nursing Service Providers | Registered Nurse |
No ID Information.