MEDICARE: VIVIENE THOMPSON

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	778823	NY

General Provider Information

NPI Number	:	1083340541
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	VIVIENE THOMPSON

Provider Business Mailing Address
First Line	:	502 SUPERIOR RD
Second Line	:
City	:	EGG HARBOR TOWNSHIP
State	:	NJ
Zip	:	08234-4939
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	502 SUPERIOR RD
Second Line	:
City	:	EGG HARBOR TOWNSHIP
State	:	NJ
Zip	:	08234-4939
Country	:	US
Telephone Number	:	973-336-3204
Fax Number	:

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

Provider Enumeration Date	:	07/27/2022
Last Update Date	:	07/27/2022

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Directions to “ VIVIENE THOMPSON ” Practice Location

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