Provider Demographics
NPI:1508429630
Name:THORMAN, JESSICA L (FNP-C)
Entity Type:Individual
Prefix:
First Name:JESSICA
Middle Name:L
Last Name:THORMAN
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1207 E THOMAS ST
Mailing Address - Street 2:
Mailing Address - City:MACOMB
Mailing Address - State:IL
Mailing Address - Zip Code:61455-3411
Mailing Address - Country:US
Mailing Address - Phone:309-837-0342
Mailing Address - Fax:309-305-3099
Practice Address - Street 1:1207 E THOMAS ST
Practice Address - Street 2:
Practice Address - City:MACOMB
Practice Address - State:IL
Practice Address - Zip Code:61455-3411
Practice Address - Country:US
Practice Address - Phone:309-837-0342
Practice Address - Fax:309-305-3099
Is Sole Proprietor?:No
Enumeration Date:2019-04-15
Last Update Date:2023-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IAA168028363LF0000X
IN71012440A363LF0000X
DCNP500005768363LF0000X
NM70758363LF0000X
MN9688363LF0000X
NV855980363LF0000X
WAAP61377946363LF0000X
OH0032301363LF0000X
MI4704386421363LF0000X
NE114542363LF0000X
IL277.001877363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily