Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LC0200X | Nurse Practitioner - Critical Care Medicine | 95009905 | CA |
NPI | 1215411574 |
---|---|
Provider Name | Nicole Lynise Thompson |
First Address | Temecula, CA 92590-5528 |
Second Address | Loma Linda, CA 92354-2804 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 21/09/2018 |
Last Update Date | 11/05/2020 |