Provider Demographics
NPI:1831606284
Name:THOMAS, DEIDRE ANN
Entity type:Individual
Prefix:
First Name:DEIDRE
Middle Name:ANN
Last Name:THOMAS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1686 WINCHESTER ST
Mailing Address - Street 2:
Mailing Address - City:ALLIANCE
Mailing Address - State:OH
Mailing Address - Zip Code:44601-4564
Mailing Address - Country:US
Mailing Address - Phone:330-581-8171
Mailing Address - Fax:330-680-8927
Practice Address - Street 1:1686 WINCHESTER ST
Practice Address - Street 2:
Practice Address - City:ALLIANCE
Practice Address - State:OH
Practice Address - Zip Code:44601-4564
Practice Address - Country:US
Practice Address - Phone:330-581-8171
Practice Address - Fax:330-680-8927
Is Sole Proprietor?:Yes
Enumeration Date:2018-01-08
Last Update Date:2018-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes374U00000XNursing Service Related ProvidersHome Health AideGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0241094Medicaid