Provider Demographics
NPI:1053468348
Name:THOMPSON, AMY SUZANNE (REGISTERED DIETITIAN)
Entity Type:Individual
Prefix:MRS
First Name:AMY
Middle Name:SUZANNE
Last Name:THOMPSON
Suffix:
Gender:F
Credentials:REGISTERED DIETITIAN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:421 N MADISON ST
Mailing Address - Street 2:
Mailing Address - City:LAPEER
Mailing Address - State:MI
Mailing Address - Zip Code:48446-2029
Mailing Address - Country:US
Mailing Address - Phone:810-245-4523
Mailing Address - Fax:810-245-7686
Practice Address - Street 1:421 N MADISON ST
Practice Address - Street 2:
Practice Address - City:LAPEER
Practice Address - State:MI
Practice Address - Zip Code:48446-2029
Practice Address - Country:US
Practice Address - Phone:810-245-4523
Practice Address - Fax:810-245-7686
Is Sole Proprietor?:No
Enumeration Date:2007-01-05
Last Update Date:2010-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI0D40051OtherBCBSM PIN
MI01002584OtherHEALTH PLUS OF MICHIGAN
MI01002584OtherHEALTH PLUS OF MICHIGAN
MIP20740003Medicare UPIN