Most Relevant Information
Provider Data
| NPI Number: | 1003375825 |
| Provider Name: | EBONIQUE THOMSON FNP |
| Entity Type: | Individual |
| Taxonomy Code: | 363LF0000X |
| Specialty: | Nurse Practitioner |
| License Number: | 223100 |
Most Important Dates
| Enumeration Date: | 03/19/2019 |
| Last Updated: | 03/19/2019 |
Provider Practice Location
3005 HIGHLAND PKWY
DOWNERS GROVE
IL
605155682
Practice Location Phone/Fax
| Phone: | 7162491820 |
| Fax: |
Provider Mailing Location
PO BOX 3967
KAYENTA
AZ
860333967
Provider Mailing Phone/Fax
| Phone: | 7162491820 |
| Fax: |