Healthcare Provider Details

I. General information

NPI: 1104055797
Provider Name (Legal Business Name): ROSE MARIE THOMPSON MS, RD, LD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/06/2009
Last Update Date: 07/19/2023
Certification Date: 07/19/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1127 UNIVERSITY BLVD. NE
ALBUQUERQUE NM
87102-1715
US

IV. Provider business mailing address

1127 UNIVERSITY BLVD. NE
ALBUQUERQUE NM
87102-1715
US

V. Phone/Fax

Practice location:
  • Phone: 505-272-3553
  • Fax: 505-272-6500
Mailing address:
  • Phone: 505-272-3553
  • Fax: 505-272-6500

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133VN1004X
TaxonomyPediatric Nutrition Registered Dietitian
License Number242
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: