=====================================================
General NPI Number Information
=====================================================
NPI Number | 1033480611
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | RENAE ELIZABETH THOMPSON RN
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/13/2012
-----------------------------------------------------
Last Update Date | 01/13/2012
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 4413 AMERICAN ASH DR
-----------------------------------------------------
City | MADISON
-----------------------------------------------------
State | WI
-----------------------------------------------------
Zip | 53704-1169
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 608-246-1832
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 13232 W NORTHFIELD XING
-----------------------------------------------------
City | EVANSVILLE
-----------------------------------------------------
State | WI
-----------------------------------------------------
Zip | 53536-8216
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone |
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 163W00000X
-----------------------------------------------------
Taxonomy Name | Registered Nurse
-----------------------------------------------------
License Number | 137392-030
-----------------------------------------------------
License Number State | WI
-----------------------------------------------------