1043493166 NPI number — MS. LINELL ANN THOMPSON NURSE PRACITIONER

Table of content: MS. LINELL ANN THOMPSON NURSE PRACITIONER (NPI 1043493166)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1043493166 NPI number — MS. LINELL ANN THOMPSON NURSE PRACITIONER

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
THOMPSON
Provider First Name:
LINELL
Provider Middle Name:
ANN
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
NURSE PRACITIONER
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1043493166
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
12/12/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
624 LUDINGTON ST
Provider Second Line Business Mailing Address:
#406
Provider Business Mailing Address City Name:
ESCANABA
Provider Business Mailing Address State Name:
MI
Provider Business Mailing Address Postal Code:
49829-3830
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
906-630-6984
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
719 SAN MATEO BLVD NE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ALBUQUERQUE
Provider Business Practice Location Address State Name:
NM
Provider Business Practice Location Address Postal Code:
87108-1434
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
906-630-6984
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
12/12/2007

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 363LW0102X , with the licence number:  R62755 , registered in the state of NM ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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