Provider Demographics
NPI:1043615404
Name:THOMPSON, TAMARA NICHOLE
Entity Type:Individual
Prefix:
First Name:TAMARA
Middle Name:NICHOLE
Last Name:THOMPSON
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 1:3223 N OLIVER ST
Mailing Address - Street 2:RAINBOWS UNITED, INC.
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67220-2106
Mailing Address - Country:US
Mailing Address - Phone:316-558-3430
Mailing Address - Fax:316-558-3456
Practice Address - Street 1:3223 N OLIVER ST
Practice Address - Street 2:RAINBOWS UNITED, INC.
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67220-2106
Practice Address - Country:US
Practice Address - Phone:316-558-3430
Practice Address - Fax:316-558-3430
Is Sole Proprietor?:Yes
Enumeration Date:2014-10-28
Last Update Date:2014-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator