Provider Demographics
NPI:1649966565
Name:THOMPSON, MARJORIE A (ADM LPN ADM SSER)
Entity type:Individual
Prefix:MS
First Name:MARJORIE
Middle Name:A
Last Name:THOMPSON
Suffix:
Gender:F
Credentials:ADM LPN ADM SSER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:87318 HIGHWAY 15
Mailing Address - Street 2:
Mailing Address - City:LAUREL
Mailing Address - State:NE
Mailing Address - Zip Code:68745-1916
Mailing Address - Country:US
Mailing Address - Phone:402-518-6919
Mailing Address - Fax:
Practice Address - Street 1:87318 HIGHWAY 15
Practice Address - Street 2:
Practice Address - City:LAUREL
Practice Address - State:NE
Practice Address - Zip Code:68745-1916
Practice Address - Country:US
Practice Address - Phone:402-518-6919
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-04-13
Last Update Date:2023-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE88-4281433251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health