MEDICARE: MELLISA THOMAS

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	163W00000X	Registered Nurse	041574707	IL

General Provider Information

NPI Number	:	1871448746
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MELLISA THOMAS

Provider Business Mailing Address
First Line	:	413 WATSEKA ST
Second Line	:
City	:	PARK FOREST
State	:	IL
Zip	:	60466-1307
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	413 WATSEKA ST
Second Line	:
City	:	PARK FOREST
State	:	IL
Zip	:	60466-1307
Country	:	US
Telephone Number	:	773-550-8356
Fax Number	:

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

Provider Enumeration Date	:	03/04/2026
Last Update Date	:	03/04/2026

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Directions to “ MELLISA THOMAS ” Practice Location

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