Provider Demographics
NPI:1891596094
Name:THOMPSON, TARAH LEA
Entity type:Individual
Prefix:
First Name:TARAH
Middle Name:LEA
Last Name:THOMPSON
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:211 10TH AVE NW
Mailing Address - Street 2:
Mailing Address - City:MANDAN
Mailing Address - State:ND
Mailing Address - Zip Code:58554-2641
Mailing Address - Country:US
Mailing Address - Phone:701-319-0528
Mailing Address - Fax:
Practice Address - Street 1:211 10TH AVE NW
Practice Address - Street 2:
Practice Address - City:MANDAN
Practice Address - State:ND
Practice Address - Zip Code:58554-2641
Practice Address - Country:US
Practice Address - Phone:701-319-0528
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-03-24
Last Update Date:2025-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care