Healthcare Provider Details

I. General information

NPI: 1235149543
Provider Name (Legal Business Name): RICHARD DENNIS TOMPKINS MSN, FNP-BC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/09/2006
Last Update Date: 05/13/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

49 MAPLE STREET
APPLE CREEK OH
44606
US

IV. Provider business mailing address

PO BOX 510 49 MAPLE STREET
APPLE CREEK OH
44606
US

V. Phone/Fax

Practice location:
  • Phone: 330-698-2015
  • Fax: 330-684-2045
Mailing address:
  • Phone: 330-682-5548
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number08078
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: