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Individual
ANTONIO TERELL THOMAS
Active
Individual
ANTONIO TERELL THOMAS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PMNHP
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
Primary
041563515
IL
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
Primary
209034699
IL
Other
Enumeration date
12/18/2025
Last updated
04/23/2026
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