Provider Demographics
NPI:1356393748
Name:THOMAS, JILL M (APN, CRNA)
Entity type:Individual
Prefix:MS
First Name:JILL
Middle Name:M
Last Name:THOMAS
Suffix:
Gender:F
Credentials:APN, CRNA
Other - Prefix:MS
Other - First Name:JILL
Other - Middle Name:M
Other - Last Name:JONES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CRNA
Mailing Address - Street 1:21086 W. SYLVAN DR
Mailing Address - Street 2:
Mailing Address - City:MUNDELEIN
Mailing Address - State:IL
Mailing Address - Zip Code:60060
Mailing Address - Country:US
Mailing Address - Phone:312-415-4371
Mailing Address - Fax:
Practice Address - Street 1:126 E. WING ST
Practice Address - Street 2:
Practice Address - City:ARLINGTON HEIGHTS
Practice Address - State:IL
Practice Address - Zip Code:60004
Practice Address - Country:US
Practice Address - Phone:847-368-0767
Practice Address - Fax:847-670-3483
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-16
Last Update Date:2013-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL041221368367500000X
IL209-0011952367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILL94475Medicare ID - Type Unspecified
ILS12198Medicare UPIN