Provider Demographics
NPI:1316382344
Name:THOMPSON, EILEEN CATHERINE (LPN)
Entity Type:Individual
Prefix:MRS
First Name:EILEEN
Middle Name:CATHERINE
Last Name:THOMPSON
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:MRS
Other - First Name:EILEEN
Other - Middle Name:CATHERINE
Other - Last Name:THOMPSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LPN
Mailing Address - Street 1:194 WILDWOOD PL
Mailing Address - Street 2:
Mailing Address - City:WEST SENECA
Mailing Address - State:NY
Mailing Address - Zip Code:14210-2646
Mailing Address - Country:US
Mailing Address - Phone:716-826-8704
Mailing Address - Fax:
Practice Address - Street 1:319 MIDDLESEX RD
Practice Address - Street 2:
Practice Address - City:BUFFALO
Practice Address - State:NY
Practice Address - Zip Code:14216-3140
Practice Address - Country:US
Practice Address - Phone:716-826-8704
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-05-03
Last Update Date:2013-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY065303-1164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse