Individual
MIESHA THOMAS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
1329 W 97TH ST, CHICAGO, IL 60643-1417
(773) 879-0291
Mailing address
1329 W 97TH ST, CHICAGO, IL 60643-1417
(773) 879-0291
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
209025399
IL
Other
Enumeration date
09/02/2022
Last updated
09/05/2022
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