Healthcare Provider Details

I. General information

NPI: 1497318372
Provider Name (Legal Business Name): RACHAEL ELIZABETH THOMAS BSN, APN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/17/2019
Last Update Date: 04/17/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

333 S DESPLAINES ST STE 201
CHICAGO IL
60661-5514
US

IV. Provider business mailing address

420 W BELMONT AVE APT 21C
CHICAGO IL
60657-4731
US

V. Phone/Fax

Practice location:
  • Phone: 866-258-8467
  • Fax:
Mailing address:
  • Phone: 512-663-0381
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LW0102X
TaxonomyWomen's Health Nurse Practitioner
License Number209.019214
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: