1700039492 NPI number — MRS. JESSICA LYNN THOMPSON LPN

Table of content: MRS. JESSICA LYNN THOMPSON LPN (NPI 1700039492)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1700039492 NPI number — MRS. JESSICA LYNN THOMPSON LPN

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
THOMPSON
Provider First Name:
JESSICA
Provider Middle Name:
LYNN
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
LPN
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:
1700039492
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
10/28/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
26 HAYES ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
WILLARD
Provider Business Mailing Address State Name:
OH
Provider Business Mailing Address Postal Code:
44890-1174
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
567-224-7748
Provider Business Mailing Address Fax Number:
419-935-1912

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
26 HAYES ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WILLARD
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
44890-1174
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
567-224-7748
Provider Business Practice Location Address Fax Number:
419-935-1912
Provider Enumeration Date:
10/28/2008

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: 164W00000X , with the licence number:  PN 125827 IV , registered in the state of OH ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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