Provider Demographics
NPI:1386218188
Name:THOMPSON, MARY HELEN (RN)
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:HELEN
Last Name:THOMPSON
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:MARY
Other - Middle Name:HELEN
Other - Last Name:VANDERWERF
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:3418 NW BRYCE CANYON LN
Mailing Address - Street 2:
Mailing Address - City:BEND
Mailing Address - State:OR
Mailing Address - Zip Code:97703-6723
Mailing Address - Country:US
Mailing Address - Phone:907-250-0778
Mailing Address - Fax:
Practice Address - Street 1:3418 NW BRYCE CANYON LN
Practice Address - Street 2:
Practice Address - City:BEND
Practice Address - State:OR
Practice Address - Zip Code:97703-6723
Practice Address - Country:US
Practice Address - Phone:907-250-0778
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-05-17
Last Update Date:2021-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR08507308RN163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes163W00000XNursing Service ProvidersRegistered NurseGroup - Single Specialty