Provider Demographics
NPI:1336319151
Name:THOMPSON, ELIZABETH RUTH (LPN IV)
Entity Type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:RUTH
Last Name:THOMPSON
Suffix:
Gender:F
Credentials:LPN IV
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:546 PARK AVE
Mailing Address - Street 2:
Mailing Address - City:GALION
Mailing Address - State:OH
Mailing Address - Zip Code:44833-1240
Mailing Address - Country:US
Mailing Address - Phone:419-564-3239
Mailing Address - Fax:
Practice Address - Street 1:546 PARK AVE
Practice Address - Street 2:
Practice Address - City:GALION
Practice Address - State:OH
Practice Address - Zip Code:44833-1240
Practice Address - Country:US
Practice Address - Phone:419-564-3239
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-03-07
Last Update Date:2008-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH122338164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse