Provider Demographics
NPI:1154702322
Name:THOMAS, KATARA SHENEE
Entity type:Individual
Prefix:
First Name:KATARA
Middle Name:SHENEE
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 1:4751 COUNTRY LN APT A16
Mailing Address - Street 2:
Mailing Address - City:WARRENSVILLE HEIGHTS
Mailing Address - State:OH
Mailing Address - Zip Code:44128-5834
Mailing Address - Country:US
Mailing Address - Phone:216-785-4665
Mailing Address - Fax:
Practice Address - Street 1:4751 COUNTRY LN APT A16
Practice Address - Street 2:
Practice Address - City:WARRENSVILLE HEIGHTS
Practice Address - State:OH
Practice Address - Zip Code:44128-5834
Practice Address - Country:US
Practice Address - Phone:216-785-4665
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-06-14
Last Update Date:2015-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH400705330108376K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376K00000XNursing Service Related ProvidersNurse's Aide