Provider Demographics
NPI:1356070064
Name:THOMSEN, AMY JANE
Entity Type:Individual
Prefix:
First Name:AMY
Middle Name:JANE
Last Name:THOMSEN
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 1:1107 E MAIN ST
Mailing Address - Street 2:
Mailing Address - City:CLARKSBURG
Mailing Address - State:WV
Mailing Address - Zip Code:26301-3227
Mailing Address - Country:US
Mailing Address - Phone:304-629-8175
Mailing Address - Fax:
Practice Address - Street 1:1107 E MAIN ST
Practice Address - Street 2:
Practice Address - City:CLARKSBURG
Practice Address - State:WV
Practice Address - Zip Code:26301-3227
Practice Address - Country:US
Practice Address - Phone:304-629-8175
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-06-08
Last Update Date:2022-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant