Healthcare Provider Details

I. General information

NPI: 1073420089
Provider Name (Legal Business Name): JAMIE J THOMPSON
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/25/2026
Last Update Date: 08/25/2026
Certification Date: 08/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3014 W SCOTT ST
MILWAUKEE WI
53215-1643
US

IV. Provider business mailing address

2236 W BOLIVAR AVE
MILWAUKEE WI
53221-2216
US

V. Phone/Fax

Practice location:
  • Phone: 414-902-9531
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WP0200X
TaxonomyPediatric Registered Nurse
License Number136826
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: