Healthcare Provider Details

I. General information

NPI: 1831294073
Provider Name (Legal Business Name): SYLVIA ANN THOMPSON RN, CPED
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/13/2006
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12830 63RD AVE SE
SNOHOMISH WA
98296-4254
US

IV. Provider business mailing address

12830 63RD AVE SE
SNOHOMISH WA
98296-4254
US

V. Phone/Fax

Practice location:
  • Phone: 509-392-3943
  • Fax: 509-834-7103
Mailing address:
  • Phone: 509-392-3943
  • Fax: 509-834-7103

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WC1500X
TaxonomyCommunity Health Registered Nurse
License NumberRN00117663
License Number StateWA
# 2
Primary TaxonomyN
Taxonomy Code224L00000X
TaxonomyPedorthist
License NumberCPED2653
License Number StateWA
# 3
Primary TaxonomyN
Taxonomy Code332BC3200X
TaxonomyCustomized Equipment (DME)
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN00117663
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: