Provider Demographics
NPI:1811547185
Name:THOMPSON, FANCY V
Entity Type:Individual
Prefix:
First Name:FANCY
Middle Name:V
Last Name: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 1:6511 PORT ELIZABETH
Mailing Address - Street 2:
Mailing Address - City:CONVERSE
Mailing Address - State:TX
Mailing Address - Zip Code:78109-3801
Mailing Address - Country:US
Mailing Address - Phone:210-931-6319
Mailing Address - Fax:
Practice Address - Street 1:403 SLUMBER PASS
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78260-5547
Practice Address - Country:US
Practice Address - Phone:210-931-6319
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-09-18
Last Update Date:2019-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747A0650XNursing Service Related ProvidersTechnicianAttendant Care Provider