Provider Demographics
NPI:1780957183
Name:THOMPSON, NORCOMAS CHARLOS (NA)
Entity type:Individual
Prefix:MR
First Name:NORCOMAS
Middle Name:CHARLOS
Last Name:THOMPSON
Suffix:
Gender:M
Credentials:NA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3817 S LANCASTER RD
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75216-5632
Mailing Address - Country:US
Mailing Address - Phone:469-853-4253
Mailing Address - Fax:
Practice Address - Street 1:3817 S LANCASTER RD
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75216-5632
Practice Address - Country:US
Practice Address - Phone:469-853-4253
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-02-15
Last Update Date:2012-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX12005726374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide