Provider Demographics
NPI:1255783569
Name:THOMPSON, AFFYA S (LPN)
Entity type:Individual
Prefix:
First Name:AFFYA
Middle Name:S
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 1:1465 WASHINGTON AVE
Mailing Address - Street 2:APT. BH
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10456-1913
Mailing Address - Country:US
Mailing Address - Phone:347-932-0890
Mailing Address - Fax:
Practice Address - Street 1:1465 WASHINGTON AVE
Practice Address - Street 2:APT. BH
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10456-1913
Practice Address - Country:US
Practice Address - Phone:347-932-0890
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-07-11
Last Update Date:2016-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY325744164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse