Provider Demographics
NPI:1356445621
Name:THOMPSON, TAMMIE L (CNS)
Entity Type:Individual
Prefix:
First Name:TAMMIE
Middle Name:L
Last Name:THOMPSON
Suffix:
Gender:F
Credentials:CNS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2600 SIXTH ST SW
Mailing Address - Street 2:CANCER CENTER
Mailing Address - City:CANTON
Mailing Address - State:OH
Mailing Address - Zip Code:44710
Mailing Address - Country:US
Mailing Address - Phone:330-453-3309
Mailing Address - Fax:330-363-7413
Practice Address - Street 1:2600 SIXTH ST SW
Practice Address - Street 2:CANCER CENTER
Practice Address - City:CANTON
Practice Address - State:OH
Practice Address - Zip Code:44710
Practice Address - Country:US
Practice Address - Phone:330-453-3309
Practice Address - Fax:330-363-7413
Is Sole Proprietor?:No
Enumeration Date:2006-09-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHRN196264364SX0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes364SX0200XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistOncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
THNS03271Medicare ID - Type Unspecified
Q51172Medicare UPIN