Healthcare Provider Details

I. General information

NPI: 1821287350
Provider Name (Legal Business Name): MRS. LANAY MICHELLE THOMPSON
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/22/2007
Last Update Date: 10/22/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1726 RYEWOOD RD
BALTIMORE MD
21234-6815
US

IV. Provider business mailing address

1726 RYEWOOD RD
BALTIMORE MD
21234-6815
US

V. Phone/Fax

Practice location:
  • Phone: 410-668-0281
  • Fax:
Mailing address:
  • Phone: 410-668-0281
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code376K00000X
TaxonomyNurse's Aide
License NumberA00074459
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: