Provider Demographics
NPI:1558346247
Name:THOMPSON, GLORIA DENISE
Entity Type:Individual
Prefix:
First Name:GLORIA
Middle Name:DENISE
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 1:200 MARTIN DR
Mailing Address - Street 2:APT #49
Mailing Address - City:MC GEHEE
Mailing Address - State:AR
Mailing Address - Zip Code:71654-2663
Mailing Address - Country:US
Mailing Address - Phone:870-222-2870
Mailing Address - Fax:
Practice Address - Street 1:901 S 3RD ST
Practice Address - Street 2:
Practice Address - City:MC GEHEE
Practice Address - State:AR
Practice Address - Zip Code:71654-2563
Practice Address - Country:US
Practice Address - Phone:870-222-3805
Practice Address - Fax:870-222-3984
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-12-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant