Provider Demographics
NPI:1679691687
Name:THOMPSON, PEARL AUDREY (RN)
Entity Type:Individual
Prefix:
First Name:PEARL
Middle Name:AUDREY
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 1:5010 FLYNNHAVEN CT
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43221-5811
Mailing Address - Country:US
Mailing Address - Phone:614-679-3098
Mailing Address - Fax:614-777-8949
Practice Address - Street 1:5010 FLYNNHAVEN CT
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43221-5811
Practice Address - Country:US
Practice Address - Phone:614-679-3098
Practice Address - Fax:614-777-8949
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHRN.311355163WM0705X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WM0705XNursing Service ProvidersRegistered NurseMedical-Surgical