Healthcare Provider Details

I. General information

NPI: 1922723014
Provider Name (Legal Business Name): DEANA THOMPSON NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/11/2022
Last Update Date: 07/16/2026
Certification Date: 07/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1260 N IRISH RD STE B
DAVISON MI
48423-2276
US

IV. Provider business mailing address

1260 N IRISH RD STE B
DAVISON MI
48423-2276
US

V. Phone/Fax

Practice location:
  • Phone: 810-653-0899
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number4704369456
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: