Provider Demographics
NPI:1396191540
Name:THOMPSON, JORIE R (PA-C)
Entity Type:Individual
Prefix:MS
First Name:JORIE
Middle Name:R
Last Name:THOMPSON
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:302 RANDALL RD STE 206
Mailing Address - Street 2:
Mailing Address - City:GENEVA
Mailing Address - State:IL
Mailing Address - Zip Code:60134-4219
Mailing Address - Country:US
Mailing Address - Phone:331-732-4600
Mailing Address - Fax:331-732-4602
Practice Address - Street 1:302 RANDALL RD STE 206
Practice Address - Street 2:
Practice Address - City:GENEVA
Practice Address - State:IL
Practice Address - Zip Code:60134-4219
Practice Address - Country:US
Practice Address - Phone:331-732-4600
Practice Address - Fax:331-732-4602
Is Sole Proprietor?:No
Enumeration Date:2016-05-06
Last Update Date:2022-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL085005482363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant