Provider Demographics
NPI:1720212897
Name:THOMPSON, DANA MARIE (IDMT)
Entity Type:Individual
Prefix:
First Name:DANA
Middle Name:MARIE
Last Name:THOMPSON
Suffix:
Gender:F
Credentials:IDMT
Other - Prefix:
Other - First Name:DANA
Other - Middle Name:MARIE
Other - Last Name:MIGLETS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:819 RHS/SG
Mailing Address - Street 2:6944 GODDARD DRIVE
Mailing Address - City:MALMSTROM AFB
Mailing Address - State:MT
Mailing Address - Zip Code:59404
Mailing Address - Country:US
Mailing Address - Phone:406-632-3644
Mailing Address - Fax:
Practice Address - Street 1:819 RHS/SG
Practice Address - Street 2:6944 GODDARD DRIVE
Practice Address - City:MALMSTROM AFB
Practice Address - State:MT
Practice Address - Zip Code:59404
Practice Address - Country:US
Practice Address - Phone:406-868-7913
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-05-05
Last Update Date:2009-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1710I1003XOther Service ProvidersMilitary Health Care ProviderIndependent Duty Medical Technicians