Healthcare Provider Details

I. General information

NPI: 1255859328
Provider Name (Legal Business Name): TIA YVETTE THOMPSON CNM
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/08/2017
Last Update Date: 01/03/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6600 BRUCEVILLE RD
SACRAMENTO CA
95823-4671
US

IV. Provider business mailing address

1017 L ST
SACRAMENTO CA
95814-3805
US

V. Phone/Fax

Practice location:
  • Phone: 916-688-2569
  • Fax:
Mailing address:
  • Phone: 916-912-2186
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code176B00000X
TaxonomyMidwife
License Number235833
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: