Provider Demographics
NPI:1477567741
Name:THOMPSON, CHERYL JEANN (RD)
Entity Type:Individual
Prefix:MS
First Name:CHERYL
Middle Name:JEANN
Last Name:THOMPSON
Suffix:
Gender:F
Credentials:RD
Other - Prefix:
Other - First Name:CHERYL
Other - Middle Name:JEANN
Other - Last Name:GENOVESE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RD
Mailing Address - Street 1:10957 RHODE ISLAND AVE S
Mailing Address - Street 2:
Mailing Address - City:BLOOMINGTON
Mailing Address - State:MN
Mailing Address - Zip Code:55438-2373
Mailing Address - Country:US
Mailing Address - Phone:952-946-1872
Mailing Address - Fax:
Practice Address - Street 1:1 VETERANS DR
Practice Address - Street 2:
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55417-2309
Practice Address - Country:US
Practice Address - Phone:612-467-2552
Practice Address - Fax:612-727-5997
Is Sole Proprietor?:No
Enumeration Date:2006-07-29
Last Update Date:2007-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN1118133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered