Provider Demographics
NPI:1427532266
Name:THOMPSON, IVY G
Entity type:Individual
Prefix:
First Name:IVY
Middle Name:G
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 1:1300 DALLAS DR APT 1011
Mailing Address - Street 2:
Mailing Address - City:DENTON
Mailing Address - State:TX
Mailing Address - Zip Code:76205-6608
Mailing Address - Country:US
Mailing Address - Phone:940-808-8945
Mailing Address - Fax:
Practice Address - Street 1:1300 DALLAS DR APT 1011
Practice Address - Street 2:
Practice Address - City:DENTON
Practice Address - State:TX
Practice Address - Zip Code:76205-6608
Practice Address - Country:US
Practice Address - Phone:940-808-8945
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-09-18
Last Update Date:2018-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX195592164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse