Healthcare Provider Details

I. General information

NPI: 1437745528
Provider Name (Legal Business Name): ALISON NOEL THOMPSON FNP-B
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/14/2020
Last Update Date: 04/06/2021
Certification Date: 04/06/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

385 ESTELLA AVE
RIGBY ID
83442-1136
US

IV. Provider business mailing address

950 HOSPITAL WAY STE A
POCATELLO ID
83201
US

V. Phone/Fax

Practice location:
  • Phone: 208-201-3902
  • Fax:
Mailing address:
  • Phone: 801-266-5633
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number66047
License Number StateID

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: