Provider Demographics
NPI:1659837771
Name:THOMPSON, RENEE (PA-C)
Entity Type:Individual
Prefix:
First Name:RENEE
Middle Name:
Last Name:THOMPSON
Suffix:
Gender:F
Credentials:PA-C
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Other - Credentials:
Mailing Address - Street 1:7210 LOMA LINDA DR NE
Mailing Address - Street 2:
Mailing Address - City:ROCKFORD
Mailing Address - State:MI
Mailing Address - Zip Code:49341-9455
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:490 BLUE HILLS AVENUE
Practice Address - Street 2:
Practice Address - City:HARTFORD
Practice Address - State:CT
Practice Address - Zip Code:06112
Practice Address - Country:US
Practice Address - Phone:860-714-2149
Practice Address - Fax:806-714-8933
Is Sole Proprietor?:No
Enumeration Date:2019-02-13
Last Update Date:2021-12-15
Deactivation Date:
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant