Provider Demographics
NPI:1518167246
Name:THOMAS, JUANITA FELISHA (NURSE AIDE)
Entity Type:Individual
Prefix:
First Name:JUANITA
Middle Name:FELISHA
Last Name:THOMAS
Suffix:
Gender:F
Credentials:NURSE AIDE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8420 SAINT OLAF DR
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63134-1110
Mailing Address - Country:US
Mailing Address - Phone:314-824-7476
Mailing Address - Fax:
Practice Address - Street 1:4144 LINDELL BLVD STE 317
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63108-2953
Practice Address - Country:US
Practice Address - Phone:314-824-7476
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-20
Last Update Date:2014-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
372600000X, 372500000X, 374U00000X, 376J00000X
MO2004399376K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376K00000XNursing Service Related ProvidersNurse's Aide
No372600000XNursing Service Related ProvidersAdult Companion
No372500000XNursing Service Related ProvidersChore Provider
No374U00000XNursing Service Related ProvidersHome Health Aide
No376J00000XNursing Service Related ProvidersHomemaker