Provider Demographics
NPI:1497029987
Name:THOMPSON, LISA KATHLEEN (ND)
Entity Type:Individual
Prefix:DR
First Name:LISA
Middle Name:KATHLEEN
Last Name:THOMPSON
Suffix:
Gender:F
Credentials:ND
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:945 PEPPERWOOD LN
Mailing Address - Street 2:
Mailing Address - City:PETALUMA
Mailing Address - State:CA
Mailing Address - Zip Code:94952-2191
Mailing Address - Country:US
Mailing Address - Phone:858-337-6632
Mailing Address - Fax:858-346-9110
Practice Address - Street 1:945 PEPPERWOOD LN
Practice Address - Street 2:
Practice Address - City:PETALUMA
Practice Address - State:CA
Practice Address - Zip Code:94952-2191
Practice Address - Country:US
Practice Address - Phone:858-337-6632
Practice Address - Fax:858-346-9110
Is Sole Proprietor?:Yes
Enumeration Date:2012-02-29
Last Update Date:2012-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAND-513175F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175F00000XOther Service ProvidersNaturopath