Individual
JACLYN MARIE THOBABEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
1025 MAINE ST, QUINCY, IL 62301-4038
(217) 222-6550
Mailing address
1025 MAINE ST, QUINCY, IL 62301-4038
(217) 222-6550
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
0010-01743
NC
363A00000X
Physician Assistant
Primary
085005012
IL
Other
Enumeration date
03/03/2009
Last updated
05/20/2014
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