Healthcare Provider Details

I. General information

NPI: 1154866556
Provider Name (Legal Business Name): TONI THOMPSON RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/21/2016
Last Update Date: 12/21/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

400 NE 3RD ST
PRINEVILLE OR
97754-1921
US

IV. Provider business mailing address

1256 NW 20TH ST
REDMOND OR
97756-7465
US

V. Phone/Fax

Practice location:
  • Phone: 541-323-7122
  • Fax:
Mailing address:
  • Phone: 541-323-7122
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WC1500X
TaxonomyCommunity Health Registered Nurse
License Number096003050RN
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: