Provider Demographics
NPI:1669240776
Name:THOMPSON, JULIA JANE (FNP-BC)
Entity type:Individual
Prefix:
First Name:JULIA
Middle Name:JANE
Last Name:THOMPSON
Suffix:
Gender:F
Credentials:FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1443 E EVERGREEN DR APT 303
Mailing Address - Street 2:
Mailing Address - City:PALATINE
Mailing Address - State:IL
Mailing Address - Zip Code:60074-8732
Mailing Address - Country:US
Mailing Address - Phone:630-273-1217
Mailing Address - Fax:
Practice Address - Street 1:1443 E EVERGREEN DR APT 303
Practice Address - Street 2:
Practice Address - City:PALATINE
Practice Address - State:IL
Practice Address - Zip Code:60074-8732
Practice Address - Country:US
Practice Address - Phone:630-273-1217
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-12-18
Last Update Date:2023-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209028741363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner