MEDICARE: MS. EARLINE THOMAS RN.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	163W00000X	Registered Nurse	041238216	IL

General Provider Information

NPI Number	:	1689196834
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. EARLINE THOMAS RN.

Provider Business Mailing Address
First Line	:	6221 S EMERALD DR
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60621-2059
Country	:	US
Telephone Number	:	321-338-6600
Fax Number	:	312-338-6628

Provider Business Practice Location Address
First Line	:	6454 S RHODES AVE
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60637-3313
Country	:	US
Telephone Number	:	773-497-8137
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/10/2017
Last Update Date	:	07/10/2017

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