Provider Demographics
NPI:1235565995
Name:THOMPSON, CAMILE JENIEVE
Entity Type:Individual
Prefix:
First Name:CAMILE
Middle Name:JENIEVE
Last Name:THOMPSON
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 1:4220 HUTCHINSON RIVER PKWY E
Mailing Address - Street 2:25 C
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10475-4726
Mailing Address - Country:US
Mailing Address - Phone:646-685-9602
Mailing Address - Fax:
Practice Address - Street 1:4220 HUTCHINSON RIVER PKWY E
Practice Address - Street 2:25 C
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10475-4726
Practice Address - Country:US
Practice Address - Phone:646-685-9602
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-09-25
Last Update Date:2013-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY291623-1164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse