Provider Demographics
NPI:1710587639
Name:THOMSPON, STEVEN WHEELER KNIGHT
Entity Type:Individual
Prefix:
First Name:STEVEN
Middle Name:WHEELER KNIGHT
Last Name:THOMSPON
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1433
Mailing Address - Street 2:
Mailing Address - City:MORENO VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:92556-1433
Mailing Address - Country:US
Mailing Address - Phone:951-318-1485
Mailing Address - Fax:
Practice Address - Street 1:10960 POPPY FIELD CIR
Practice Address - Street 2:
Practice Address - City:MORENO VALLEY
Practice Address - State:CA
Practice Address - Zip Code:92557-3912
Practice Address - Country:US
Practice Address - Phone:951-318-1485
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-10-29
Last Update Date:2020-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAVN690691164X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164X00000XNursing Service ProvidersLicensed Vocational Nurse