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General NPI Number Information
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NPI Number | 1811547185
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Entity Type | Individual
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Provider Name | FANCY V THOMPSON
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Gender | Female
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Dates
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Enumeration Date | 09/18/2019
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Last Update Date | 09/18/2019
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Provider Practice Location Address
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Address Line | 403 SLUMBER PASS
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City | SAN ANTONIO
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State | TX
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Zip | 78260-5547
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Country | US
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Telephone | 210-931-6319
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Fax |
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Provider Business Mailing Address
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Address Line | 6511 PORT ELIZABETH
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City | CONVERSE
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State | TX
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Zip | 78109-3801
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Country | US
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Telephone | 210-931-6319
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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 | 3747A0650X
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Taxonomy Name | Attendant Care Provider
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License Number |
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License Number State |
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