1598102907 NPI number — MRS. RENATE DAWN THOMPSON L.M.P

Table of content: MRS. RENATE DAWN THOMPSON L.M.P (NPI 1598102907)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1598102907 NPI number — MRS. RENATE DAWN THOMPSON L.M.P

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
THOMPSON
Provider First Name:
RENATE
Provider Middle Name:
DAWN
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
L.M.P
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
FRITSCH
Provider Other First Name:
RENATE
Provider Other Middle Name:
DAWN
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
L.M.P
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1598102907
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
11/04/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
9511 OLD NACHES HWY
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
NACHES
Provider Business Mailing Address State Name:
WA
Provider Business Mailing Address Postal Code:
98937-8777
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
509-480-9646
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3910 SUMMITVIEW AVE
Provider Second Line Business Practice Location Address:
SUITE #210
Provider Business Practice Location Address City Name:
YAKIMA
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98902-2780
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-480-9646
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
05/24/2013

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: 225700000X , with the licence number:  MA60327278 , registered in the state of WA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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