Provider Demographics
NPI:1558988386
Name:THOMPSON, ROISIN (LAC)
Entity Type:Individual
Prefix:
First Name:ROISIN
Middle Name:
Last Name:THOMPSON
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:275 MARKET ST STE 409
Mailing Address - Street 2:
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55405-1625
Mailing Address - Country:US
Mailing Address - Phone:612-323-0754
Mailing Address - Fax:
Practice Address - Street 1:275 MARKET ST STE 409
Practice Address - Street 2:
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55405-1625
Practice Address - Country:US
Practice Address - Phone:612-323-0754
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-06-27
Last Update Date:2020-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN1882171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist