Healthcare Provider Details

I. General information

NPI: 1639319155
Provider Name (Legal Business Name): PAULA J THOMPSON RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: PAULA THOMPSON RN

II. Dates (important events)

Enumeration Date: 02/23/2009
Last Update Date: 02/23/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1407 SAINT ANDREW ST
LA CROSSE WI
54603-3301
US

IV. Provider business mailing address

215 PETERSON ST
HOLMEN WI
54636-8802
US

V. Phone/Fax

Practice location:
  • Phone: 608-785-6266
  • Fax:
Mailing address:
  • Phone: 608-769-9133
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WC1500X
TaxonomyCommunity Health Registered Nurse
License Number152298-30
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: