Provider Demographics
NPI:1730659657
Name:THOMAS, AJA R (DN)
Entity Type:Individual
Prefix:
First Name:AJA
Middle Name:R
Last Name:THOMAS
Suffix:
Gender:F
Credentials:DN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3501 W 2ND ST
Mailing Address - Street 2:
Mailing Address - City:DAYTON
Mailing Address - State:OH
Mailing Address - Zip Code:45417-1709
Mailing Address - Country:US
Mailing Address - Phone:937-238-7475
Mailing Address - Fax:
Practice Address - Street 1:3501 W 2ND ST
Practice Address - Street 2:
Practice Address - City:DAYTON
Practice Address - State:OH
Practice Address - Zip Code:45417-1709
Practice Address - Country:US
Practice Address - Phone:937-238-7475
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-12-04
Last Update Date:2018-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHDD001495403747A0650X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747A0650XNursing Service Related ProvidersTechnicianAttendant Care Provider
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHDD00149540OtherEIGHT-HOUR PROVIDER TRAINING
OH2C1159E0-6F5D-11E8-AOtherDELEGATED NURSING