Healthcare Provider Details

I. General information

NPI: 1881036960
Provider Name (Legal Business Name): CARRIE ANN THOMPSON RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/18/2013
Last Update Date: 07/18/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

901 W MEM DR
HOUGHTON MI
49931-2475
US

IV. Provider business mailing address

901 W MEM DR
HOUGHTON MI
49931-2475
US

V. Phone/Fax

Practice location:
  • Phone: 906-482-9400
  • Fax: 906-482-9794
Mailing address:
  • Phone: 906-482-9400
  • Fax: 906-482-9794

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number4704254863
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: