Individual
JENNA M THOMAS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
6375 US HIGHWAY 6 STE C, PORTAGE, IN 46368-5218
(219) 947-6129
(219) 703-6705
Mailing address
8558 BROADWAY, MERRILLVILLE, IN 46410-7032
(219) 392-7084
(219) 703-6854
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
10004174A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
300052493
—
IN
Enumeration date
09/18/2023
Last updated
10/28/2023
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