Provider Demographics
NPI:1073159349
Name:THOMPSON, HEATHER RAE (CAREGIVER)
Entity Type:Individual
Prefix:
First Name:HEATHER
Middle Name:RAE
Last Name:THOMPSON
Suffix:
Gender:F
Credentials:CAREGIVER
Other - Prefix:
Other - First Name:HEATHER
Other - Middle Name:RAE
Other - Last Name:WATSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CAREGIVER
Mailing Address - Street 1:30 MAPLE DR
Mailing Address - Street 2:
Mailing Address - City:WEISER
Mailing Address - State:ID
Mailing Address - Zip Code:83672-1566
Mailing Address - Country:US
Mailing Address - Phone:208-230-1826
Mailing Address - Fax:
Practice Address - Street 1:30 MAPLE DR
Practice Address - Street 2:
Practice Address - City:WEISER
Practice Address - State:ID
Practice Address - Zip Code:83672-1566
Practice Address - Country:US
Practice Address - Phone:208-230-1826
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-11-21
Last Update Date:2019-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care