Provider Demographics
NPI:1689661589
Name:THOMPSON, STEPHANIE J (LPN)
Entity Type:Individual
Prefix:MS
First Name:STEPHANIE
Middle Name:J
Last Name:THOMPSON
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:98-402 KOAUKA LOOP
Mailing Address - Street 2:#1911
Mailing Address - City:AIEA
Mailing Address - State:HI
Mailing Address - Zip Code:96701-4510
Mailing Address - Country:US
Mailing Address - Phone:720-335-5920
Mailing Address - Fax:
Practice Address - Street 1:98-402 KOAUKA LOOP
Practice Address - Street 2:#1911
Practice Address - City:AIEA
Practice Address - State:HI
Practice Address - Zip Code:96701-4510
Practice Address - Country:US
Practice Address - Phone:720-335-5920
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-10-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HI15230164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse