Provider Demographics
NPI:1043482482
Name:TOMPKINS, JAN
Entity Type:Individual
Prefix:
First Name:JAN
Middle Name:
Last Name:TOMPKINS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16 OLD WALNUT ST
Mailing Address - Street 2:
Mailing Address - City:CATSKILL
Mailing Address - State:NY
Mailing Address - Zip Code:12414
Mailing Address - Country:US
Mailing Address - Phone:914-424-9076
Mailing Address - Fax:
Practice Address - Street 1:16 OLD WALNUT ST
Practice Address - Street 2:
Practice Address - City:CATSKILL
Practice Address - State:NY
Practice Address - Zip Code:12414-6915
Practice Address - Country:US
Practice Address - Phone:914-424-9076
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-03-26
Last Update Date:2008-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY226462-1164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse