Provider Demographics
NPI:1871095109
Name:THOMAS, ELMIRA B (APN)
Entity type:Individual
Prefix:MS
First Name:ELMIRA
Middle Name:B
Last Name:THOMAS
Suffix:
Gender:F
Credentials:APN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3426 S KING DR
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60616-4194
Mailing Address - Country:US
Mailing Address - Phone:773-459-8578
Mailing Address - Fax:773-486-8823
Practice Address - Street 1:2434 W DIVISION ST
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60622-2942
Practice Address - Country:US
Practice Address - Phone:773-486-8820
Practice Address - Fax:773-486-8823
Is Sole Proprietor?:Yes
Enumeration Date:2018-03-02
Last Update Date:2018-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209016846363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health