Provider Demographics
NPI:1710632062
Name:PRESTON-THOMPSON, SIERRA NICOLE
Entity Type:Individual
Prefix:
First Name:SIERRA
Middle Name:NICOLE
Last Name:PRESTON-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 1:132 GLYNBROOK ST N STE 200
Mailing Address - Street 2:
Mailing Address - City:KEIZER
Mailing Address - State:OR
Mailing Address - Zip Code:97303-5796
Mailing Address - Country:US
Mailing Address - Phone:971-227-9808
Mailing Address - Fax:
Practice Address - Street 1:132 GLYNBROOK ST N
Practice Address - Street 2:
Practice Address - City:KEIZER
Practice Address - State:OR
Practice Address - Zip Code:97303-5796
Practice Address - Country:US
Practice Address - Phone:971-227-9808
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-02-15
Last Update Date:2022-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator