Provider Demographics
NPI:1194072314
Name:THOMPSON, ANGELA ALICE
Entity type:Individual
Prefix:
First Name:ANGELA
Middle Name:ALICE
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 1:839 E 45TH ST
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11203-5721
Mailing Address - Country:US
Mailing Address - Phone:718-451-2493
Mailing Address - Fax:
Practice Address - Street 1:316 5TH AVE
Practice Address - Street 2:ROOM 404
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10001-3602
Practice Address - Country:US
Practice Address - Phone:212-868-0946
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-08-07
Last Update Date:2014-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY307183164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse