Healthcare Provider Details

I. General information

NPI: 1063569481
Provider Name (Legal Business Name): RICHELE LYNN THOMPSON CNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/05/2007
Last Update Date: 01/23/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1320 MERCY DR NW
CANTON OH
44708-2614
US

IV. Provider business mailing address

7388 HAWKSFIELD AVE NW
CANAL FULTON OH
44614-8135
US

V. Phone/Fax

Practice location:
  • Phone: 330-489-1111
  • Fax:
Mailing address:
  • Phone: 330-854-1190
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LW0102X
TaxonomyWomen's Health Nurse Practitioner
License NumberNP-08927
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: