Provider Demographics
NPI:1235706060
Name:THOMPSON, SANDRA (RN)
Entity Type:Individual
Prefix:
First Name:SANDRA
Middle Name:
Last Name:THOMPSON
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:395 8TH AVE
Mailing Address - Street 2:
Mailing Address - City:TERRE HAUTE
Mailing Address - State:IN
Mailing Address - Zip Code:47804-4064
Mailing Address - Country:US
Mailing Address - Phone:812-234-7111
Mailing Address - Fax:
Practice Address - Street 1:395 8TH AVE
Practice Address - Street 2:
Practice Address - City:TERRE HAUTE
Practice Address - State:IN
Practice Address - Zip Code:47804-4064
Practice Address - Country:US
Practice Address - Phone:812-234-7111
Practice Address - Fax:812-234-7333
Is Sole Proprietor?:No
Enumeration Date:2021-06-09
Last Update Date:2021-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN28077074A163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse