Provider Demographics
NPI:1295954915
Name:THOMAS, MARY ELLA (RN)
Entity type:Individual
Prefix:
First Name:MARY
Middle Name:ELLA
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:PO BOX 272034
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43227-8034
Mailing Address - Country:US
Mailing Address - Phone:740-973-5131
Mailing Address - Fax:614-948-1140
Practice Address - Street 1:5554 ALBANY SPRINGS DR
Practice Address - Street 2:
Practice Address - City:WESTERVILLE
Practice Address - State:OH
Practice Address - Zip Code:43081-7001
Practice Address - Country:US
Practice Address - Phone:740-973-5131
Practice Address - Fax:614-948-1140
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHRN-291271163WH0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WH0200XNursing Service ProvidersRegistered NurseHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2408362OtherINDEPENDENT PROVIDER #