Provider Demographics
NPI:1801346770
Name:THOMPSON, ANDRENA MICSHELL
Entity type:Individual
Prefix:MS
First Name:ANDRENA
Middle Name:MICSHELL
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 1:1307 KINDERWAY AVE
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:SC
Mailing Address - Zip Code:29203-5895
Mailing Address - Country:US
Mailing Address - Phone:803-730-1368
Mailing Address - Fax:
Practice Address - Street 1:1307 KINDERWAY AVE
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29203-5895
Practice Address - Country:US
Practice Address - Phone:803-730-1368
Practice Address - Fax:803-360-5902
Is Sole Proprietor?:Yes
Enumeration Date:2016-10-04
Last Update Date:2016-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide