Healthcare Provider Details

I. General information

NPI: 1528519758
Provider Name (Legal Business Name): BETTY XIONG-THOMPSON PA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: BETTY XIONG

II. Dates (important events)

Enumeration Date: 10/24/2016
Last Update Date: 12/16/2025
Certification Date: 12/16/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

210 WISCONSIN AMERICAN DR
FOND DU LAC WI
54937
US

IV. Provider business mailing address

PO BOX 735044
CHICAGO IL
60673-5044
US

V. Phone/Fax

Practice location:
  • Phone: 920-907-7000
  • Fax: 920-907-7162
Mailing address:
  • Phone: 800-326-2250
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number3933-23
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: