Provider Demographics
NPI:1386475614
Name:THOMPSON, AMIE LEE
Entity type:Individual
Prefix:
First Name:AMIE
Middle Name:LEE
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 1:318 BROOKDALE DR APT A
Mailing Address - Street 2:
Mailing Address - City:BLOOMINGDALE
Mailing Address - State:IL
Mailing Address - Zip Code:60108-3540
Mailing Address - Country:US
Mailing Address - Phone:773-860-2260
Mailing Address - Fax:
Practice Address - Street 1:318 BROOKDALE DR APT A
Practice Address - Street 2:
Practice Address - City:BLOOMINGDALE
Practice Address - State:IL
Practice Address - Zip Code:60108-3540
Practice Address - Country:US
Practice Address - Phone:773-860-2260
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-08-08
Last Update Date:2024-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)