Healthcare Provider Details

I. General information

NPI: 1912833039
Provider Name (Legal Business Name): SOPHIA THOMPSON RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/18/2026
Last Update Date: 06/18/2026
Certification Date: 06/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

PO BOX 170520
BOZEMAN MT
59717-0520
US

IV. Provider business mailing address

712 W SPRUCE ST APT 404
MISSOULA MT
59802-4064
US

V. Phone/Fax

Practice location:
  • Phone: 496-994-7510
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberNUR-RN-LIC-213261
License Number StateMT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: