MEDICARE: MRS. RENAE ELIZABETH THOMPSON RN

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	163W00000X	Registered Nurse	137392-030	WI

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1033480611
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. RENAE ELIZABETH THOMPSON RN

Provider Business Mailing Address
First Line	:	13232 W NORTHFIELD XING
Second Line	:
City	:	EVANSVILLE
State	:	WI
Zip	:	53536-8216
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	4413 AMERICAN ASH DR
Second Line	:
City	:	MADISON
State	:	WI
Zip	:	53704-1169
Country	:	US
Telephone Number	:	608-246-1832
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/13/2012
Last Update Date	:	01/13/2012

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