Healthcare Provider Details

I. General information

NPI: 1447587837
Provider Name (Legal Business Name): BARBARA JEAN THOMPSON FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/05/2009
Last Update Date: 07/18/2024
Certification Date: 07/18/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

17495 LA GRANGE RD
TINLEY PARK IL
60487-7581
US

IV. Provider business mailing address

PO BOX 713260
CHICAGO IL
60677-1353
US

V. Phone/Fax

Practice location:
  • Phone: 630-364-7850
  • Fax: 708-226-7172
Mailing address:
  • Phone: 630-469-9200
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number209.008376
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number041349974
License Number StateIL
# 3
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number277000826
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: