Provider Demographics
NPI:1174032023
Name:THOMPSON, DEENA R (NTP)
Entity Type:Individual
Prefix:
First Name:DEENA
Middle Name:R
Last Name:THOMPSON
Suffix:
Gender:F
Credentials:NTP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:544 TAMALPAIS DR
Mailing Address - Street 2:
Mailing Address - City:MILL VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:94941-2603
Mailing Address - Country:US
Mailing Address - Phone:801-885-9682
Mailing Address - Fax:
Practice Address - Street 1:544 TAMALPAIS DR
Practice Address - Street 2:
Practice Address - City:MILL VALLEY
Practice Address - State:CA
Practice Address - Zip Code:94941-2603
Practice Address - Country:US
Practice Address - Phone:801-885-9682
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-09-22
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133N00000XDietary & Nutritional Service ProvidersNutritionist