Healthcare Provider Details

I. General information

NPI: 1881231918
Provider Name (Legal Business Name): HEATHER D THOMPSON RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/09/2019
Last Update Date: 12/09/2019
Certification Date: 12/09/2019
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20840 478TH AVE
WHITE SD
57276-5904
US

IV. Provider business mailing address

20840 478TH AVE
WHITE SD
57276-5904
US

V. Phone/Fax

Practice location:
  • Phone: 605-651-4666
  • Fax:
Mailing address:
  • Phone: 605-651-4666
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WM0705X
TaxonomyMedical-Surgical Registered Nurse
License NumberR047657
License Number StateSD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: