Provider Demographics
NPI:1265815039
Name:THOMPSON, MAURIE MICHELLE (LPN)
Entity Type:Individual
Prefix:
First Name:MAURIE
Middle Name:MICHELLE
Last Name:THOMPSON
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:23154 FOUNTAIN DR
Mailing Address - Street 2:
Mailing Address - City:CLINTON TOWNSHIP
Mailing Address - State:MI
Mailing Address - Zip Code:48036-1292
Mailing Address - Country:US
Mailing Address - Phone:313-909-3013
Mailing Address - Fax:586-913-7408
Practice Address - Street 1:23154 FOUNTAIN DR
Practice Address - Street 2:
Practice Address - City:CLINTON TOWNSHIP
Practice Address - State:MI
Practice Address - Zip Code:48036-1292
Practice Address - Country:US
Practice Address - Phone:313-909-3013
Practice Address - Fax:586-913-7408
Is Sole Proprietor?:No
Enumeration Date:2015-06-29
Last Update Date:2015-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4703104557164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse