Provider Demographics
NPI:1760829923
Name:THOMPSON, CASEY (LPN)
Entity Type:Individual
Prefix:
First Name:CASEY
Middle Name:
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 1:63611 FRAZEE LN
Mailing Address - Street 2:
Mailing Address - City:MCARTHUR
Mailing Address - State:OH
Mailing Address - Zip Code:45651
Mailing Address - Country:US
Mailing Address - Phone:740-856-2437
Mailing Address - Fax:
Practice Address - Street 1:63611 FRAZEE LN
Practice Address - Street 2:
Practice Address - City:MC ARTHUR
Practice Address - State:OH
Practice Address - Zip Code:45651-8486
Practice Address - Country:US
Practice Address - Phone:740-856-2437
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-05-29
Last Update Date:2013-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPN120400164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse