Provider Demographics
NPI:1609324862
Name:THOMAS, ENSLEY SR
Entity Type:Individual
Prefix:
First Name:ENSLEY
Middle Name:
Last Name:THOMAS
Suffix:SR
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1408 AUTUMN DR NW
Mailing Address - Street 2:
Mailing Address - City:WARREN
Mailing Address - State:OH
Mailing Address - Zip Code:44485-2032
Mailing Address - Country:US
Mailing Address - Phone:330-469-4707
Mailing Address - Fax:
Practice Address - Street 1:1408 AUTUMN DR NW
Practice Address - Street 2:
Practice Address - City:WARREN
Practice Address - State:OH
Practice Address - Zip Code:44485-2032
Practice Address - Country:US
Practice Address - Phone:330-469-4707
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-09-16
Last Update Date:2016-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376K00000XNursing Service Related ProvidersNurse's Aide