| NPI | 1730699778 |
|---|---|
| Former Name | TINA M THOMAS |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: IL 209016559) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: IL 209.016559) |
| Enumeration Date | 2017-10-04 |
| Last Update Date | 2023-05-02 |