Provider Demographics
NPI:1982125522
Name:THOMSON, STEPHANIE (MS,RDN)
Entity Type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:
Last Name:THOMSON
Suffix:
Gender:F
Credentials:MS,RDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 732
Mailing Address - Street 2:
Mailing Address - City:SEDALIA
Mailing Address - State:CO
Mailing Address - Zip Code:80135-0732
Mailing Address - Country:US
Mailing Address - Phone:720-459-0913
Mailing Address - Fax:
Practice Address - Street 1:2505 BIG BEAR CIR
Practice Address - Street 2:
Practice Address - City:SEDALIA
Practice Address - State:CO
Practice Address - Zip Code:80135-4433
Practice Address - Country:US
Practice Address - Phone:720-459-0913
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-07-05
Last Update Date:2017-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered