Provider Demographics
NPI:1497324479
Name:THOMPSON, CHRISTLE RENEE (NURSE PRACTITIONER)
Entity Type:Individual
Prefix:
First Name:CHRISTLE
Middle Name:RENEE
Last Name:THOMPSON
Suffix:
Gender:F
Credentials:NURSE PRACTITIONER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:37898 W GREENWOOD DR
Mailing Address - Street 2:
Mailing Address - City:NORTHVILLE
Mailing Address - State:MI
Mailing Address - Zip Code:48167-9096
Mailing Address - Country:US
Mailing Address - Phone:248-921-6284
Mailing Address - Fax:
Practice Address - Street 1:660 WOODWARD AVE
Practice Address - Street 2:
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48226-3516
Practice Address - Country:US
Practice Address - Phone:313-457-9355
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-06-23
Last Update Date:2023-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704229213363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner