Provider Demographics
NPI:1487832705
Name:THOMPSON, DARYL JAMES (RN)
Entity Type:Individual
Prefix:
First Name:DARYL
Middle Name:JAMES
Last Name:THOMPSON
Suffix:
Gender:M
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:44551 HILLVIEW DR
Mailing Address - Street 2:
Mailing Address - City:RUSHFORD
Mailing Address - State:MN
Mailing Address - Zip Code:55971-5085
Mailing Address - Country:US
Mailing Address - Phone:507-864-3636
Mailing Address - Fax:507-864-3646
Practice Address - Street 1:44551 HILLVIEW DR
Practice Address - Street 2:
Practice Address - City:RUSHFORD
Practice Address - State:MN
Practice Address - Zip Code:55971-5085
Practice Address - Country:US
Practice Address - Phone:507-864-3636
Practice Address - Fax:507-864-3646
Is Sole Proprietor?:No
Enumeration Date:2008-02-08
Last Update Date:2008-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN1272154163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse