Individual
ASHLY MATHEW THOMAS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
7447 W TALCOTT AVE STE 512, CHICAGO, IL 60631-3716
(773) 774-1790
(773) 774-1796
Mailing address
1000 N BURNING BUSH LN, MT PROSPECT, IL 60056-1833
(847) 331-2125
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
209.021810
IL
363LA2200X
Adult Health Nurse Practitioner
209.021810
IL
363LG0600X
Gerontology Nurse Practitioner
Primary
209.021810
IL
Other
Enumeration date
08/20/2020
Last updated
03/09/2022
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