Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LW0102X | Nurse Practitioner - Women's Health | NP-08927 | OH |
NPI | 1063569481 |
---|---|
Provider Name | Richele Lynn Thompson |
First Address | Canal Fulton, OH 44614-8135 |
Second Address | Canton, OH 44708-2614 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 05/01/2007 |
Last Update Date | 23/01/2008 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1063569481 | INDIVIDUAL NPI (01) | OH |
1376559799 | GROUP NPI (01) | OH |
2745122 | (05) | OH |
Q77319 | (02) | OH |