Healthcare Provider Details

I. General information

NPI: 1275219933
Provider Name (Legal Business Name): NANETTE C THOMAS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/26/2023
Last Update Date: 06/26/2023
Certification Date: 06/26/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

311 N 2ND ST STE 203
ST CHARLES IL
60174-1850
US

IV. Provider business mailing address

1810 BECKHAM LN
ST CHARLES IL
60174-5001
US

V. Phone/Fax

Practice location:
  • Phone: 630-377-5105
  • Fax:
Mailing address:
  • Phone: 847-687-8683
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number178.015489
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: