Provider Demographics
NPI:1982076378
Name:DAVID-THOMPSON, MAXINE (RN)
Entity Type:Individual
Prefix:
First Name:MAXINE
Middle Name:
Last Name:DAVID-THOMPSON
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:125 N MARY AVE
Mailing Address - Street 2:SPC 68
Mailing Address - City:SUNNYVALE
Mailing Address - State:CA
Mailing Address - Zip Code:94086-4820
Mailing Address - Country:US
Mailing Address - Phone:510-294-9214
Mailing Address - Fax:
Practice Address - Street 1:818 W A ST
Practice Address - Street 2:APT 38
Practice Address - City:HAYWARD
Practice Address - State:CA
Practice Address - Zip Code:94541-5870
Practice Address - Country:US
Practice Address - Phone:336-448-9971
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-10-23
Last Update Date:2016-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA739222163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse