Healthcare Provider Details

I. General information

NPI: 1205157872
Provider Name (Legal Business Name): ELIZABETH FAYE THOMPSON NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/18/2010
Last Update Date: 10/15/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

750 E 34TH ST FAIRVIEW RANGE MEDICAL CENTER
HIBBING MN
55746-2341
US

IV. Provider business mailing address

750 E 34TH ST FAIRVIEW RANGE MEDICAL CENTER
HIBBING MN
55746-2341
US

V. Phone/Fax

Practice location:
  • Phone: 218-362-6343
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WH0200X
TaxonomyHome Health Registered Nurse
License NumberR 185101-2
License Number StateMN
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberR185101-2
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: