Healthcare Provider Details

I. General information

NPI: 1609165117
Provider Name (Legal Business Name): EMILY MARIE THOMPSON RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/05/2011
Last Update Date: 04/05/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

759 260TH AVE
AVOCA MN
56114-1066
US

IV. Provider business mailing address

759 260TH AVE
AVOCA MN
56114-1066
US

V. Phone/Fax

Practice location:
  • Phone: 507-360-4366
  • Fax:
Mailing address:
  • Phone: 507-360-4366
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberR1618433
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: