Provider Demographics
NPI:1831435189
Name:THOMPSON, RENA (APN)
Entity type:Individual
Prefix:MS
First Name:RENA
Middle Name:
Last Name:THOMPSON
Suffix:
Gender:F
Credentials:APN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7537 N BELL AVE
Mailing Address - Street 2:STE 1
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60645-2484
Mailing Address - Country:US
Mailing Address - Phone:773-973-5837
Mailing Address - Fax:
Practice Address - Street 1:7537 N BELL AVE
Practice Address - Street 2:SUITE 1
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60645-2484
Practice Address - Country:US
Practice Address - Phone:773-702-3786
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-12-13
Last Update Date:2012-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209008818364S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes364S00000XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse Specialist