Provider Demographics
NPI:1629530282
Name:THOMAS, FANTAZHA
Entity Type:Individual
Prefix:
First Name:FANTAZHA
Middle Name:
Last Name:THOMAS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8075 READING RD STE 300C
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45237-1416
Mailing Address - Country:US
Mailing Address - Phone:513-202-4045
Mailing Address - Fax:513-873-9979
Practice Address - Street 1:8075 READING RD STE 300C
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45237-1416
Practice Address - Country:US
Practice Address - Phone:513-202-4045
Practice Address - Fax:513-873-9979
Is Sole Proprietor?:Yes
Enumeration Date:2019-04-03
Last Update Date:2019-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHB23882956OtherPRIVATE PAY