Provider Demographics
NPI:1912382656
Name:THOMAS, JESSICA (RN)
Entity Type:Individual
Prefix:
First Name:JESSICA
Middle Name:
Last Name:THOMAS
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:80600 STATE RD # 258
Mailing Address - Street 2:
Mailing Address - City:TIPPECANOE
Mailing Address - State:OH
Mailing Address - Zip Code:44699-9753
Mailing Address - Country:US
Mailing Address - Phone:330-340-0829
Mailing Address - Fax:
Practice Address - Street 1:80600 STATE RD # 258
Practice Address - Street 2:
Practice Address - City:TIPPECANOE
Practice Address - State:OH
Practice Address - Zip Code:44699-9753
Practice Address - Country:US
Practice Address - Phone:330-340-0829
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-07-23
Last Update Date:2015-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHRN363689163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse