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General NPI Number Information
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NPI Number | 1104393115
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Entity Type | Individual
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Provider Name | LAURALEA THOMAS NP
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Gender | Female
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Dates
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Enumeration Date | 10/28/2018
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Last Update Date | 10/28/2018
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Provider Practice Location Address
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Address Line | 111 S WASHINGTON AVE STE 202
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City | PARK RIDGE
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State | IL
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Zip | 60068-4293
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Country | US
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Telephone | 847-423-6800
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Fax |
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Provider Business Mailing Address
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Address Line | 4029 N FRANCISCO AVE # 1N
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City | CHICAGO
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State | IL
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Zip | 60618-2601
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Country | US
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Telephone | 847-331-2458
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 209.018226
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License Number State | IL
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