Healthcare Provider Details

I. General information

NPI: 1326943523
Provider Name (Legal Business Name): HEATHER J. THOMPSON RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/09/2026
Last Update Date: 10/09/2026
Certification Date: 10/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

374 LAKE ST
WILSON NY
14172-9507
US

IV. Provider business mailing address

374 LAKE ST
WILSON NY
14172-9507
US

V. Phone/Fax

Practice location:
  • Phone: 716-751-9341
  • Fax:
Mailing address:
  • Phone: 716-751-9341
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WS0200X
TaxonomySchool Registered Nurse
License Number518490
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: