Provider Demographics
NPI:1053089912
Name:THOMSPON, MYOSHI
Entity Type:Individual
Prefix:
First Name:MYOSHI
Middle Name:
Last Name:THOMSPON
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 1:2107 ROOSEVELT AVE
Mailing Address - Street 2:
Mailing Address - City:LORAIN
Mailing Address - State:OH
Mailing Address - Zip Code:44055-3429
Mailing Address - Country:US
Mailing Address - Phone:440-581-3347
Mailing Address - Fax:
Practice Address - Street 1:33355 HEALTH CAMPUS BLVD
Practice Address - Street 2:
Practice Address - City:AVON
Practice Address - State:OH
Practice Address - Zip Code:44011-1399
Practice Address - Country:US
Practice Address - Phone:440-937-9099
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-09-03
Last Update Date:2021-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251J00000XAgenciesNursing Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH109382963-00Medicaid