Provider Demographics
NPI:1669843694
Name:THOMPSON, VERONICA DALLIS (RN)
Entity Type:Individual
Prefix:MISS
First Name:VERONICA
Middle Name:DALLIS
Last Name:THOMPSON
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1042 E 232ND ST
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10466-4812
Mailing Address - Country:US
Mailing Address - Phone:646-318-0541
Mailing Address - Fax:
Practice Address - Street 1:1042 E 232ND ST
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10466-4812
Practice Address - Country:US
Practice Address - Phone:646-318-0541
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-10-16
Last Update Date:2015-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY550213-1163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse