Provider Demographics
NPI:1699365015
Name:THOMPSON, HAZEL DYNETTE (RN)
Entity Type:Individual
Prefix:
First Name:HAZEL
Middle Name:DYNETTE
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 1:17118 CALICO PEAK WAY
Mailing Address - Street 2:
Mailing Address - City:CYPRESS
Mailing Address - State:TX
Mailing Address - Zip Code:77433-1984
Mailing Address - Country:US
Mailing Address - Phone:832-419-7311
Mailing Address - Fax:
Practice Address - Street 1:17118 CALICO PEAK WAY
Practice Address - Street 2:
Practice Address - City:CYPRESS
Practice Address - State:TX
Practice Address - Zip Code:77433-1984
Practice Address - Country:US
Practice Address - Phone:832-419-7311
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-01-20
Last Update Date:2021-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX671847163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse