Provider Demographics
NPI:1376012146
Name:THOMPSON, CELINE MUKEYINA (MS, RD, LN)
Entity Type:Individual
Prefix:
First Name:CELINE
Middle Name:MUKEYINA
Last Name:THOMPSON
Suffix:
Gender:F
Credentials:MS, RD, LN
Other - Prefix:MRS
Other - First Name:CELINE
Other - Middle Name:MUKEYINA
Other - Last Name:THOMPSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CELINE KABALA, RD
Mailing Address - Street 1:PO BOX 511
Mailing Address - Street 2:
Mailing Address - City:TORONTO
Mailing Address - State:SD
Mailing Address - Zip Code:57268-0511
Mailing Address - Country:US
Mailing Address - Phone:605-496-8068
Mailing Address - Fax:
Practice Address - Street 1:650 OAHE AVE
Practice Address - Street 2:
Practice Address - City:TORONTO
Practice Address - State:SD
Practice Address - Zip Code:57268-0511
Practice Address - Country:US
Practice Address - Phone:605-496-8068
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-11-21
Last Update Date:2018-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SD0533133N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133N00000XDietary & Nutritional Service ProvidersNutritionist
Provider Identifiers
StateIdentifier IDID TypeIssuer
SD0533OtherNUTRITIONIST LICENSE