Provider Demographics
NPI:1902912173
Name:THOMPSON, JANELL M (DO)
Entity Type:Individual
Prefix:DR
First Name:JANELL
Middle Name:M
Last Name:THOMPSON
Suffix:
Gender:F
Credentials:DO
Other - Prefix:MRS
Other - First Name:JANELL
Other - Middle Name:M
Other - Last Name:THOMPSON RONDESTVEDT
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:3221 STEIN BLVD
Mailing Address - Street 2:
Mailing Address - City:EAU CLAIRE
Mailing Address - State:WI
Mailing Address - Zip Code:54701-6930
Mailing Address - Country:US
Mailing Address - Phone:715-834-2788
Mailing Address - Fax:715-834-2845
Practice Address - Street 1:3221 STEIN BLVD
Practice Address - Street 2:
Practice Address - City:EAU CLAIRE
Practice Address - State:WI
Practice Address - Zip Code:54701-6930
Practice Address - Country:US
Practice Address - Phone:715-834-2788
Practice Address - Fax:715-834-2845
Is Sole Proprietor?:No
Enumeration Date:2006-08-21
Last Update Date:2021-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI43665207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI43505800Medicaid
WI43505800Medicaid
WI000880256Medicare ID - Type Unspecified