Healthcare Provider Details

I. General information

NPI: 1073608865
Provider Name (Legal Business Name): CHARINNE THOMMEN PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/04/2006
Last Update Date: 06/01/2026
Certification Date: 06/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

17047 LA GRANGE RD
ORLAND PARK IL
60487-7227
US

IV. Provider business mailing address

17047 LA GRANGE RD
ORLAND PARK IL
60487-7227
US

V. Phone/Fax

Practice location:
  • Phone: 815-300-7264
  • Fax: 708-873-1592
Mailing address:
  • Phone: 815-300-7264
  • Fax: 708-873-1592

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number085001841
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: