Provider Demographics
NPI:1649546524
Name:THOMPSON, NKEIRUKA LAUREN
Entity type:Individual
Prefix:MRS
First Name:NKEIRUKA
Middle Name:LAUREN
Last Name:THOMPSON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:NKEIRUKA
Other - Middle Name:LAUREN
Other - Last Name:ANUGWOM
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:14327 FREDERICK ST
Mailing Address - Street 2:
Mailing Address - City:MORENO VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:92553-9041
Mailing Address - Country:US
Mailing Address - Phone:951-443-2223
Mailing Address - Fax:951-443-2255
Practice Address - Street 1:14327 FREDERICK ST
Practice Address - Street 2:
Practice Address - City:MORENO VALLEY
Practice Address - State:CA
Practice Address - Zip Code:92553
Practice Address - Country:US
Practice Address - Phone:951-443-2223
Practice Address - Fax:951-443-2255
Is Sole Proprietor?:No
Enumeration Date:2012-03-26
Last Update Date:2018-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator