Provider Demographics
NPI:1013464759
Name:MANN, TOM JOSEPH (RNFA)
Entity Type:Individual
Prefix:
First Name:TOM
Middle Name:JOSEPH
Last Name:MANN
Suffix:
Gender:M
Credentials:RNFA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7827 HIGHWAY N STE 104
Mailing Address - Street 2:
Mailing Address - City:O FALLON
Mailing Address - State:MO
Mailing Address - Zip Code:63368-6704
Mailing Address - Country:US
Mailing Address - Phone:636-377-1177
Mailing Address - Fax:636-377-1911
Practice Address - Street 1:7827 HIGHWAY N STE 104
Practice Address - Street 2:
Practice Address - City:O FALLON
Practice Address - State:MO
Practice Address - Zip Code:63368-6704
Practice Address - Country:US
Practice Address - Phone:636-377-1177
Practice Address - Fax:636-377-1911
Is Sole Proprietor?:No
Enumeration Date:2016-09-09
Last Update Date:2016-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO128361163WR0006X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WR0006XNursing Service ProvidersRegistered NurseRegistered Nurse First Assistant