Provider Demographics
NPI:1407382823
Name:THOMAS, CHANTEL EBONY (CNA)
Entity Type:Individual
Prefix:
First Name:CHANTEL
Middle Name:EBONY
Last Name:THOMAS
Suffix:
Gender:F
Credentials:CNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4246 MARTIN LUTHER KING JR DR
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:44105-6201
Mailing Address - Country:US
Mailing Address - Phone:216-450-9101
Mailing Address - Fax:
Practice Address - Street 1:4246 MARTIN LUTHER KING JR DR
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44105-6201
Practice Address - Country:US
Practice Address - Phone:216-450-9101
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-05-04
Last Update Date:2017-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide