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General NPI Number Information
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NPI Number | 1215731161
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Entity Type | Individual
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Provider Name | MARY THOMAS
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Gender | Female
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Dates
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Enumeration Date | 04/01/2025
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Last Update Date | 04/01/2025
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Provider Practice Location Address
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Address Line | 950 MILWAUKEE AVE STE 236
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City | GLENVIEW
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State | IL
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Zip | 60025-3778
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Country | US
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Telephone | 224-717-6106
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Fax |
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Provider Business Mailing Address
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Address Line | 8906 MAJOR AVE
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City | MORTON GROVE
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State | IL
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Zip | 60053-2532
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Country | US
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Telephone | 312-607-5181
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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 | 209031558
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License Number State | IL
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