MEDICARE: MS. HOLLY RENAE THOMPSON RN

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	163W00000X	Registered Nurse	513269	OH

General Provider Information

NPI Number	:	1205120961
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. HOLLY RENAE THOMPSON RN

Provider Business Mailing Address
First Line	:	4678 RILEY LN
Second Line	:
City	:	CINCINNATI
State	:	OH
Zip	:	45227-1058
Country	:	US
Telephone Number	:	513-257-9434
Fax Number	:

Provider Business Practice Location Address
First Line	:	4678 RILEY LN
Second Line	:
City	:	CINCINNATI
State	:	OH
Zip	:	45227-1058
Country	:	US
Telephone Number	:	513-257-9434
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/30/2011
Last Update Date	:	02/07/2023

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