MEDICARE: PEARL AUDREY 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	163WM0705X	Medical-Surgical Registered Nurse	RN.311355	OH

General Provider Information

NPI Number	:	1679691687
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	PEARL AUDREY THOMPSON RN

Provider Business Mailing Address
First Line	:	5010 FLYNNHAVEN CT
Second Line	:
City	:	COLUMBUS
State	:	OH
Zip	:	43221-5811
Country	:	US
Telephone Number	:	614-679-3098
Fax Number	:	614-777-8949

Provider Business Practice Location Address
First Line	:	5010 FLYNNHAVEN CT
Second Line	:
City	:	COLUMBUS
State	:	OH
Zip	:	43221-5811
Country	:	US
Telephone Number	:	614-679-3098
Fax Number	:	614-777-8949

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

Provider Enumeration Date	:	03/27/2007
Last Update Date	:	07/08/2007

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