Provider Demographics
NPI:1407085475
Name:THOMPSON, ALBERTA RAE (LPN)
Entity Type:Individual
Prefix:MS
First Name:ALBERTA
Middle Name:RAE
Last Name:THOMPSON
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:424 SMITH RD
Mailing Address - Street 2:
Mailing Address - City:GROTON
Mailing Address - State:NY
Mailing Address - Zip Code:13073
Mailing Address - Country:US
Mailing Address - Phone:607-898-9914
Mailing Address - Fax:
Practice Address - Street 1:424 SMITH RD
Practice Address - Street 2:
Practice Address - City:GROTON
Practice Address - State:NY
Practice Address - Zip Code:13073
Practice Address - Country:US
Practice Address - Phone:607-898-9914
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-07-10
Last Update Date:2009-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY215763164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse