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NPI Code Detail

MEDICARE: DR. DIANE THOMAS DNP, FNP-BC

MEDICARE: DR. DIANE THOMAS DNP, 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
1363LF0000XFamily Nurse Practitioner277000249IL

General Provider Information

NPI Number : 1992953152
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. DIANE THOMAS DNP, FNP-BC
Provider Business Mailing Address
First Line : PO BOX 746721
Second Line :
City : ATLANTA
State : GA
Zip : 30374-6721
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 3348 W 87TH ST
Second Line :
City : CHICAGO
State : IL
Zip : 60652-3767
Country : US
Telephone Number : 773-776-4471
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/29/2008
Last Update Date : 04/07/2022

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