Provider Demographics
NPI:1790506004
Name:THOMAS, WONDERFUL
Entity type:Individual
Prefix:
First Name:WONDERFUL
Middle Name:
Last Name:THOMAS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:WONDERFUL
Other - Middle Name:
Other - Last Name:JENNINGS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1036 EDWIN CT UNIT 4
Mailing Address - Street 2:
Mailing Address - City:WILLOUGHBY
Mailing Address - State:OH
Mailing Address - Zip Code:44094-7284
Mailing Address - Country:US
Mailing Address - Phone:216-338-3401
Mailing Address - Fax:
Practice Address - Street 1:1036 EDWIN CT UNIT 4
Practice Address - Street 2:
Practice Address - City:WILLOUGHBY
Practice Address - State:OH
Practice Address - Zip Code:44094-7284
Practice Address - Country:US
Practice Address - Phone:440-530-8873
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-10-19
Last Update Date:2024-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide