Provider Demographics
NPI:1427363753
Name:THOMPSON, CAROL A (LPN /NT/ DM NUR)
Entity Type:Individual
Prefix:MRS
First Name:CAROL
Middle Name:A
Last Name:THOMPSON
Suffix:
Gender:F
Credentials:LPN /NT/ DM NUR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1735 CONVERSE DR
Mailing Address - Street 2:
Mailing Address - City:FLORENCE
Mailing Address - State:SC
Mailing Address - Zip Code:29501-6568
Mailing Address - Country:US
Mailing Address - Phone:843-621-0249
Mailing Address - Fax:
Practice Address - Street 1:1735 CONVERSE DR
Practice Address - Street 2:
Practice Address - City:FLORENCE
Practice Address - State:SC
Practice Address - Zip Code:29501-6568
Practice Address - Country:US
Practice Address - Phone:843-621-0249
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-08-11
Last Update Date:2010-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SCPR22121164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse