Provider Demographics
NPI:1689007759
Name:THOMPSON, ZOANN C
Entity Type:Individual
Prefix:MS
First Name:ZOANN
Middle Name:C
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 1:5 WILLOWBROOK LN APT 2
Mailing Address - Street 2:
Mailing Address - City:MANLIUS
Mailing Address - State:NY
Mailing Address - Zip Code:13104-1723
Mailing Address - Country:US
Mailing Address - Phone:315-778-9880
Mailing Address - Fax:
Practice Address - Street 1:5 WILLOWBROOK LN APT 2
Practice Address - Street 2:
Practice Address - City:MANLIUS
Practice Address - State:NY
Practice Address - Zip Code:13104-1723
Practice Address - Country:US
Practice Address - Phone:315-778-9880
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-08-13
Last Update Date:2013-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY341596030301E376K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376K00000XNursing Service Related ProvidersNurse's Aide