MEDICARE: TERESA DAWN THOMPSON

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	171M00000X	Case Manager/Care Coordinator

General Provider Information

NPI Number	:	1639675036
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TERESA DAWN THOMPSON

Provider Business Mailing Address
First Line	:	7229 BLUEBIRD
Second Line	:
City	:	WATERFORD TOWNSHIP
State	:	MI
Zip	:	48329-2803
Country	:	US
Telephone Number	:	248-935-3803
Fax Number	:

Provider Business Practice Location Address
First Line	:	7229 BLUEBIRD
Second Line	:
City	:	WATERFORD TOWNSHIP
State	:	MI
Zip	:	48329-2803
Country	:	US
Telephone Number	:	248-935-3803
Fax Number	:

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

Provider Enumeration Date	:	04/04/2018
Last Update Date	:	04/04/2018

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