Provider Demographics
NPI:1356880280
Name:THOMAS, TONJA (NURSE AIDE)
Entity type:Individual
Prefix:
First Name:TONJA
Middle Name:
Last Name:THOMAS
Suffix:
Gender:F
Credentials:NURSE AIDE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4004 VICTORY BLVD
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:44135-1546
Mailing Address - Country:US
Mailing Address - Phone:216-882-5009
Mailing Address - Fax:
Practice Address - Street 1:4004 VICTORY BLVD
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44135-1546
Practice Address - Country:US
Practice Address - Phone:216-882-5009
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-02-12
Last Update Date:2017-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH400523780806376K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376K00000XNursing Service Related ProvidersNurse's Aide