Provider Demographics
NPI:1063885937
Name:THOMAS BASH, AMY FAYE (APN)
Entity type:Individual
Prefix:
First Name:AMY
Middle Name:FAYE
Last Name:THOMAS BASH
Suffix:
Gender:F
Credentials:APN
Other - Prefix:
Other - First Name:AMY
Other - Middle Name:FAYE
Other - Last Name:THOMAS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2900 N LAKE SHORE DR
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60657-5640
Mailing Address - Country:US
Mailing Address - Phone:773-665-3200
Mailing Address - Fax:773-665-0000
Practice Address - Street 1:2900 N LAKE SHORE DR
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60657-5640
Practice Address - Country:US
Practice Address - Phone:773-665-3200
Practice Address - Fax:773-665-0000
Is Sole Proprietor?:No
Enumeration Date:2015-11-02
Last Update Date:2015-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209.011516363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner