Healthcare Provider Details

I. General information

NPI: 1124641741
Provider Name (Legal Business Name): JEANETTE THOMPSON
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/19/2020
Last Update Date: 05/19/2020
Certification Date: 05/19/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

21 BLAISDELL RD
NORTH MONMOUTH ME
04265-6226
US

IV. Provider business mailing address

21 BLAISDELL RD
NORTH MONMOUTH ME
04265-6226
US

V. Phone/Fax

Practice location:
  • Phone: 207-441-1554
  • Fax:
Mailing address:
  • Phone: 207-441-1554
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3747A0650X
TaxonomyAttendant Care Provider
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: