Healthcare Provider Details

I. General information

NPI: 1306765649
Provider Name (Legal Business Name): MOIRA THOMPSON
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/11/2026
Last Update Date: 07/11/2026
Certification Date: 07/12/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

821 W OKLAHOMA AVE STE 2
GRAND ISLAND NE
68801-6781
US

IV. Provider business mailing address

726 E PHILIP AVE APT 101
NORTH PLATTE NE
69101-6180
US

V. Phone/Fax

Practice location:
  • Phone: 308-381-1690
  • Fax:
Mailing address:
  • Phone: 702-721-2710
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code372600000X
TaxonomyAdult Companion
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: