Healthcare Provider Details

I. General information

NPI: 1346780756
Provider Name (Legal Business Name): CARLA ANN THOMAS APN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/03/2017
Last Update Date: 01/26/2022
Certification Date: 01/26/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

801 S WASHINGTON ST
NAPERVILLE IL
60540-7430
US

IV. Provider business mailing address

1417 FOREST RD
LA GRANGE PARK IL
60526-1120
US

V. Phone/Fax

Practice location:
  • Phone: 630-527-3000
  • Fax:
Mailing address:
  • Phone: 708-715-7954
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number209015521
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: