Healthcare Provider Details

I. General information

NPI: 1225045487
Provider Name (Legal Business Name): DIRK WALTER THOMPSON LVN
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/01/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

651 I ST
SACRAMENTO CA
95814-2400
US

IV. Provider business mailing address

2025 W EL CAMINO AVE APT 262
SACRAMENTO CA
95833-1430
US

V. Phone/Fax

Practice location:
  • Phone: 916-874-5222
  • Fax:
Mailing address:
  • Phone: 916-320-3720
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code164X00000X
TaxonomyLicensed Vocational Nurse
License NumberVN151825
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: