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General NPI Number Information
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NPI Number | 1497324479
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Entity Type | Individual
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Provider Name | CHRISTLE RENEE THOMPSON NURSE PRACTITIONER
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Gender | Female
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Dates
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Enumeration Date | 06/23/2021
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Last Update Date | 03/11/2023
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Provider Practice Location Address
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Address Line | 660 WOODWARD AVE
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City | DETROIT
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State | MI
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Zip | 48226-3516
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Country | US
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Telephone | 313-457-9355
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Fax |
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Provider Business Mailing Address
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Address Line | 37898 W GREENWOOD DR
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City | NORTHVILLE
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State | MI
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Zip | 48167-9096
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Country | US
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Telephone | 248-921-6284
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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 | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number | 4704229213
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License Number State | MI
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