Healthcare Provider Details

I. General information

NPI: 1639701766
Provider Name (Legal Business Name): SAVANNAH LOUISE THOMPSON FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/06/2020
Last Update Date: 07/15/2026
Certification Date: 07/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4700 GREENFIELD RD
DEARBORN MI
48126-4124
US

IV. Provider business mailing address

14645 ABINGTON AVE
DETROIT MI
48227-1409
US

V. Phone/Fax

Practice location:
  • Phone: 313-740-1111
  • Fax:
Mailing address:
  • Phone: 313-576-7809
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number4704247863
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: