Provider Demographics
NPI:1639615339
Name:THOMPSON, LAWANDA
Entity type:Individual
Prefix:
First Name:LAWANDA
Middle Name:
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 1:10 HONOR DR
Mailing Address - Street 2:
Mailing Address - City:FORT MITCHELL
Mailing Address - State:AL
Mailing Address - Zip Code:36856-2802
Mailing Address - Country:US
Mailing Address - Phone:706-289-2522
Mailing Address - Fax:
Practice Address - Street 1:10 HONOR DR
Practice Address - Street 2:
Practice Address - City:FORT MITCHELL
Practice Address - State:AL
Practice Address - Zip Code:36856-2802
Practice Address - Country:US
Practice Address - Phone:706-289-2522
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-01-18
Last Update Date:2024-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide