Provider Demographics
NPI:1851579288
Name:THOMPSON, EVELYN LAVERN (LVN)
Entity Type:Individual
Prefix:MRS
First Name:EVELYN
Middle Name:LAVERN
Last Name:THOMPSON
Suffix:
Gender:F
Credentials:LVN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12279 LASSELLE ST
Mailing Address - Street 2:
Mailing Address - City:MORENO VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:92557-7705
Mailing Address - Country:US
Mailing Address - Phone:951-485-6847
Mailing Address - Fax:951-485-6847
Practice Address - Street 1:12279 LASSELLE ST
Practice Address - Street 2:
Practice Address - City:MORENO VALLEY
Practice Address - State:CA
Practice Address - Zip Code:92557-7705
Practice Address - Country:US
Practice Address - Phone:951-485-6847
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-02-07
Last Update Date:2008-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAVN129832164X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164X00000XNursing Service ProvidersLicensed Vocational Nurse