Provider Demographics
NPI:1972813509
Name:THOMAS, QIANA MARIE (LPN)
Entity Type:Individual
Prefix:
First Name:QIANA
Middle Name:MARIE
Last Name:THOMAS
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:QIANA
Other - Middle Name:MARIE
Other - Last Name:WOOLFORK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LPN
Mailing Address - Street 1:5425 TURNEY RD
Mailing Address - Street 2:UPPER NORTH
Mailing Address - City:GARFIELD HEIGHTS
Mailing Address - State:OH
Mailing Address - Zip Code:44125-3203
Mailing Address - Country:US
Mailing Address - Phone:216-256-6616
Mailing Address - Fax:
Practice Address - Street 1:5425 TURNEY RD
Practice Address - Street 2:UPPER NORTH
Practice Address - City:GARFIELD HEIGHTS
Practice Address - State:OH
Practice Address - Zip Code:44125-3203
Practice Address - Country:US
Practice Address - Phone:216-256-6616
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-10-17
Last Update Date:2010-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPN.123552-M-IV164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse