Provider Demographics
NPI:1801833892
Name:THOMPSON, CARENA MAY (DO)
Entity Type:Individual
Prefix:DR
First Name:CARENA
Middle Name:MAY
Last Name:THOMPSON
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:CARENA
Other - Middle Name:M
Other - Last Name:BLACKETER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:P.O. DRAWER 367
Mailing Address - Street 2:NIMIIPUU HEALTH, 111 BEAVER GRADE ROAD
Mailing Address - City:LAPWAI
Mailing Address - State:ID
Mailing Address - Zip Code:83540-0367
Mailing Address - Country:US
Mailing Address - Phone:208-843-2842
Mailing Address - Fax:
Practice Address - Street 1:111 BEAVER GRADE ROAD
Practice Address - Street 2:
Practice Address - City:LAPWAI
Practice Address - State:ID
Practice Address - Zip Code:83540-0367
Practice Address - Country:US
Practice Address - Phone:208-843-2842
Practice Address - Fax:309-527-3525
Is Sole Proprietor?:No
Enumeration Date:2006-05-31
Last Update Date:2011-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA3676207Q00000X
IL036123865207Q00000X
IL336.086682207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL336086682OtherILLINOIS CONTROLLED SUBSTANCE #