Provider Demographics
NPI:1902037344
Name:THOMAS, OLEKACHI JEAN (IDMT)
Entity Type:Individual
Prefix:MRS
First Name:OLEKACHI
Middle Name:JEAN
Last Name:THOMAS
Suffix:
Gender:F
Credentials:IDMT
Other - Prefix:
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Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:4700 LAS VEGAS BLVD N
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89191-6600
Mailing Address - Country:US
Mailing Address - Phone:702-653-3435
Mailing Address - Fax:
Practice Address - Street 1:5537 DIANO MARINA CT
Practice Address - Street 2:
Practice Address - City:NORTH LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89081-4078
Practice Address - Country:US
Practice Address - Phone:702-653-3435
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-08-03
Last Update Date:2010-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1710I1003XOther Service ProvidersMilitary Health Care ProviderIndependent Duty Medical Technicians