Provider Demographics
NPI:1144575754
Name:THOMPSON, VERDIE LEE (RN, PHN, MSN, PNP)
Entity Type:Individual
Prefix:MS
First Name:VERDIE
Middle Name:LEE
Last Name:THOMPSON
Suffix:
Gender:F
Credentials:RN, PHN, MSN, PNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1103 12TH ST
Mailing Address - Street 2:
Mailing Address - City:OAKLAND
Mailing Address - State:CA
Mailing Address - Zip Code:94607-2709
Mailing Address - Country:US
Mailing Address - Phone:510-652-3300
Mailing Address - Fax:510-652-7720
Practice Address - Street 1:2908 ELLSWORTH ST
Practice Address - Street 2:
Practice Address - City:BERKELEY
Practice Address - State:CA
Practice Address - Zip Code:94705-1912
Practice Address - Country:US
Practice Address - Phone:510-843-6194
Practice Address - Fax:510-843-6297
Is Sole Proprietor?:Yes
Enumeration Date:2012-07-19
Last Update Date:2012-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA2394363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics