MEDICARE: SHONA ELSA THOMAS MSN, FNP-BC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LF0000X	Family Nurse Practitioner	3997898	IL

General Provider Information

NPI Number	:	1821735556
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SHONA ELSA THOMAS MSN, FNP-BC

Provider Business Mailing Address
First Line	:	648 POLYNESIAN DR
Second Line	:
City	:	DES PLAINES
State	:	IL
Zip	:	60016-1134
Country	:	US
Telephone Number	:	847-529-6451
Fax Number	:

Provider Business Practice Location Address
First Line	:	2415 S MICHIGAN AVE
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60616-2301
Country	:	US
Telephone Number	:	708-486-2600
Fax Number	:	708-486-2610

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/15/2022
Last Update Date	:	09/19/2022

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