Individual
STEPHANIE LYNN THOMAS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
RD, CD
Contact information
Practice address
530 NE GLEN OAK AVE, PEORIA, IL 61637-3201
(309) 624-9844
Mailing address
302 ELGIN CT, WASHINGTON, IL 61571-1143
(219) 241-0234
Taxonomy
Speciality
Code
Description
License number
State
133V00000X
Registered Dietitian
Primary
164009191
IL
133V00000X
Registered Dietitian
37002483A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
IN3131008
MEDICARE PTAN
IN
Enumeration date
02/18/2015
Last updated
07/19/2023
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