Provider Demographics
NPI:1508635970
Name:THOMAS, GRACE PAULINA (RDN)
Entity Type:Individual
Prefix:
First Name:GRACE
Middle Name:PAULINA
Last Name:THOMAS
Suffix:
Gender:F
Credentials:RDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6515 MOHICAN DR
Mailing Address - Street 2:
Mailing Address - City:POWELL
Mailing Address - State:OH
Mailing Address - Zip Code:43065-8594
Mailing Address - Country:US
Mailing Address - Phone:614-940-3175
Mailing Address - Fax:
Practice Address - Street 1:6515 MOHICAN DR
Practice Address - Street 2:
Practice Address - City:POWELL
Practice Address - State:OH
Practice Address - Zip Code:43065-8594
Practice Address - Country:US
Practice Address - Phone:614-940-3175
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-12-27
Last Update Date:2023-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH86292912133VN1501X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133VN1501XDietary & Nutritional Service ProvidersDietitian, RegisteredNutrition, Sports Dietetics