Healthcare Provider Details

I. General information

NPI: 1255243820
Provider Name (Legal Business Name): ALEXANDRIA TINA THOMPSON
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: ALLI TINA THOMPSON

II. Dates (important events)

Enumeration Date: 09/18/2026
Last Update Date: 09/18/2026
Certification Date: 09/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

511 W PRAIRIE LN
MANDAN ND
58554-4214
US

IV. Provider business mailing address

211 10TH AVE NW
MANDAN ND
58554-2641
US

V. Phone/Fax

Practice location:
  • Phone: 701-460-0895
  • Fax:
Mailing address:
  • Phone: 701-460-0895
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code376J00000X
TaxonomyHomemaker
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: