Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207P00000X | Emergency Physician | MD12769 | HI |
N | 207PE0004X | Emergency Medical Services | 12506 | NV |
NPI | 1124057443 |
---|---|
Provider Name | Kealanalani R Thompson |
First Address | Las Vegas, NV 89107-1082 |
Second Address | Las Vegas, NV 89107-1082 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 30/06/2006 |
Last Update Date | 21/01/2015 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
55426301 | (05) | HI |
H97540 | (02) | HI |