Provider Demographics
NPI:1851832471
Name:THOMAS, TOSHA
Entity Type:Individual
Prefix:
First Name:TOSHA
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 1:4365 RAYNHAM ST
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89115-3834
Mailing Address - Country:US
Mailing Address - Phone:702-747-9888
Mailing Address - Fax:702-995-0517
Practice Address - Street 1:4365 RAYNHAM ST
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89115-3834
Practice Address - Country:US
Practice Address - Phone:702-747-9888
Practice Address - Fax:702-995-0517
Is Sole Proprietor?:No
Enumeration Date:2017-03-15
Last Update Date:2017-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV8429-PCS-0374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide