Provider Demographics
NPI:1528461548
Name:THOMPSON, EMERALD
Entity type:Individual
Prefix:
First Name:EMERALD
Middle Name:
Last Name:THOMPSON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:345 CANYONSIDE WAY APT 240
Mailing Address - Street 2:
Mailing Address - City:OCEANSIDE
Mailing Address - State:CA
Mailing Address - Zip Code:92058-7158
Mailing Address - Country:US
Mailing Address - Phone:484-651-2179
Mailing Address - Fax:
Practice Address - Street 1:345 CANYONSIDE WAY APT 240
Practice Address - Street 2:
Practice Address - City:OCEANSIDE
Practice Address - State:CA
Practice Address - Zip Code:92058-7158
Practice Address - Country:US
Practice Address - Phone:484-651-2179
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-10-04
Last Update Date:2014-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95035312163W00000X
PARN637548163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse