Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LW0102X | Nurse Practitioner - Women's Health | R62755 | NM |
NPI | 1043493166 |
---|---|
Provider Name | Ms. Linell Ann Thompson |
First Address | Escanaba, MI 49829-3830 |
Second Address | Albuquerque, NM 87108-1434 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 12/12/2007 |
Last Update Date | 12/12/2007 |