Provider Demographics
NPI:1912758939
Name:THOMPSON, LISA M (HOME HEALTH CARE)
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:M
Last Name:THOMPSON
Suffix:
Gender:F
Credentials:HOME HEALTH CARE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:412 DEBORA DR
Mailing Address - Street 2:
Mailing Address - City:GEORGETOWN
Mailing Address - State:TX
Mailing Address - Zip Code:78628-8819
Mailing Address - Country:US
Mailing Address - Phone:313-478-1913
Mailing Address - Fax:
Practice Address - Street 1:412 DEBORA DR
Practice Address - Street 2:
Practice Address - City:GEORGETOWN
Practice Address - State:TX
Practice Address - Zip Code:78628-8819
Practice Address - Country:US
Practice Address - Phone:313-478-1913
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-03-28
Last Update Date:2024-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health