Provider Demographics
NPI:1326456153
Name:THOMAS, TAMARA (STNA)
Entity Type:Individual
Prefix:MISS
First Name:TAMARA
Middle Name:
Last Name:THOMAS
Suffix:
Gender:F
Credentials:STNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4508 E 143RD ST
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:44128-2346
Mailing Address - Country:US
Mailing Address - Phone:216-254-2312
Mailing Address - Fax:
Practice Address - Street 1:4508 E 143RD ST
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44128-2346
Practice Address - Country:US
Practice Address - Phone:216-254-2312
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-07-24
Last Update Date:2014-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH400872870309376K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376K00000XNursing Service Related ProvidersNurse's Aide