Provider Demographics
NPI:1255778080
Name:THOMPSON, RICHALE JEANEANE
Entity type:Individual
Prefix:
First Name:RICHALE
Middle Name:JEANEANE
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 1:5816 CAPITOLA AVE
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89108-4734
Mailing Address - Country:US
Mailing Address - Phone:702-427-0305
Mailing Address - Fax:
Practice Address - Street 1:5327 EDNA CRANE AVE
Practice Address - Street 2:
Practice Address - City:NORTH LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89031-7989
Practice Address - Country:US
Practice Address - Phone:702-561-6510
Practice Address - Fax:702-483-6966
Is Sole Proprietor?:Yes
Enumeration Date:2013-06-03
Last Update Date:2013-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health