Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363L00000X | Nurse Practitioner | AP106323 | TX |
NPI | 1013110311 |
---|---|
Provider Name | Mrs. Brenda S. Thompson |
First Address | Dallas, TX 75284-7208 |
Second Address | Dallas, TX 75235-6243 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 06/06/2007 |
Last Update Date | 19/08/2019 |