Provider Demographics
NPI:1548461767
Name:THOMPSON, LORRAINE LAVONNE (MD)
Entity type:Individual
Prefix:DR
First Name:LORRAINE
Middle Name:LAVONNE
Last Name:THOMPSON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:450 LARIAT LN
Mailing Address - Street 2:
Mailing Address - City:ELLENSBURG
Mailing Address - State:WA
Mailing Address - Zip Code:98926-5011
Mailing Address - Country:US
Mailing Address - Phone:012-461-2365
Mailing Address - Fax:
Practice Address - Street 1:450 LARIAT LN
Practice Address - Street 2:
Practice Address - City:ELLENSBURG
Practice Address - State:WA
Practice Address - Zip Code:98926-5011
Practice Address - Country:US
Practice Address - Phone:501-246-1236
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-29
Last Update Date:2020-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARE-6336207LP3000X
WA60195227207LP3000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207LP3000XAllopathic & Osteopathic PhysiciansAnesthesiologyPediatric Anesthesiology