Healthcare Provider Details

I. General information

NPI: 1043493166
Provider Name (Legal Business Name): LINELL ANN THOMPSON NURSE PRACITIONER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/12/2007
Last Update Date: 12/12/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

719 SAN MATEO BLVD NE
ALBUQUERQUE NM
87108-1434
US

IV. Provider business mailing address

624 LUDINGTON ST #406
ESCANABA MI
49829-3830
US

V. Phone/Fax

Practice location:
  • Phone: 906-630-6984
  • Fax:
Mailing address:
  • Phone: 906-630-6984
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LW0102X
TaxonomyWomen's Health Nurse Practitioner
License NumberR62755
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: