Provider Demographics
NPI:1497291421
Name:THOMPSON, MELISSA MAE
Entity Type:Individual
Prefix:
First Name:MELISSA
Middle Name:MAE
Last Name:THOMPSON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7852 LAKEVIEW
Mailing Address - Street 2:
Mailing Address - City:HARRISON
Mailing Address - State:MI
Mailing Address - Zip Code:48625
Mailing Address - Country:US
Mailing Address - Phone:989-544-9933
Mailing Address - Fax:
Practice Address - Street 1:7852 LAKEVIEW ST
Practice Address - Street 2:
Practice Address - City:HARRISON
Practice Address - State:MI
Practice Address - Zip Code:48625-9307
Practice Address - Country:US
Practice Address - Phone:989-544-9933
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-01-14
Last Update Date:2017-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes247200000XTechnologists, Technicians & Other Technical Service ProvidersTechnician, Other