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General NPI Number Information
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NPI Number | 1174121636
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Entity Type | Individual
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Provider Name | LILLETH THOMPSON NP
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Gender | Female
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Dates
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Enumeration Date | 10/15/2020
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Last Update Date | 11/04/2020
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Provider Practice Location Address
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Address Line | 305 E 86TH ST
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City | NEW YORK
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State | NY
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Zip | 10028-4702
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Country | US
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Telephone | 904-569-9891
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Fax |
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Provider Business Mailing Address
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Address Line | 11848 233RD ST
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City | JAMAICA
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State | NY
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Zip | 11411-2228
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Country | US
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Telephone | 347-331-5617
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | F334249-01
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License Number State | NY
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