Healthcare Provider Details

I. General information

NPI: 1104980325
Provider Name (Legal Business Name): MRS. SHARON YVONNE THOMPSON
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: SHARON YVONNE CONNER

II. Dates (important events)

Enumeration Date: 12/21/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7384 W COLTER ST
GLENDALE AZ
85303
US

IV. Provider business mailing address

7384 W COLTER ST
GLENDALE AZ
85303
US

V. Phone/Fax

Practice location:
  • Phone: 623-848-6049
  • Fax: 623-848-6049
Mailing address:
  • Phone: 623-848-6049
  • Fax: 623-848-6049

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3747A0650X
TaxonomyAttendant Care Provider
License Number1736
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: