Provider Demographics
NPI:1962868661
Name:THOMAS, NICHOLE LYNN (RN)
Entity type:Individual
Prefix:MRS
First Name:NICHOLE
Middle Name:LYNN
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 1:3040 KEMP RD
Mailing Address - Street 2:
Mailing Address - City:BEAVERCREEK
Mailing Address - State:OH
Mailing Address - Zip Code:45431-2644
Mailing Address - Country:US
Mailing Address - Phone:937-458-2549
Mailing Address - Fax:
Practice Address - Street 1:3040 KEMP RD
Practice Address - Street 2:
Practice Address - City:BEAVERCREEK
Practice Address - State:OH
Practice Address - Zip Code:45431-2644
Practice Address - Country:US
Practice Address - Phone:937-458-2549
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-01-11
Last Update Date:2016-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHRN285853163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse