Basic Information
| Provider Information | |||||||||
| NPI: | 1104206879 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | THOMPSON | ||||||||
| FirstName: | ALENA | ||||||||
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| Credential: | FNP-C | ||||||||
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| Mailing Information | |||||||||
| Address1: | 118 S MOUNTAIN AVE | ||||||||
| Address2: | |||||||||
| City: | SPRINGERVILLE | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 859385104 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9283337333 | ||||||||
| FaxNumber: | 9283337157 | ||||||||
| Practice Location | |||||||||
| Address1: | 118 S MOUNTAIN AVE | ||||||||
| Address2: | |||||||||
| City: | SPRINGERVILLE | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 859385104 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9283337333 | ||||||||
| FaxNumber: | 9283337157 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/08/2015 | ||||||||
| LastUpdateDate: | 02/09/2018 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LF0000X | AP10558 | AZ | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family |
ID Information
| ID | Type | State | Issuer | Description | XT3561417 | 01 | DEA BUPRENORPHINE REGISTRATION | OTHER | MT3561417 | 01 | DEA REGISTRATION | OTHER | RN210400 | 01 | AZ | ARIZONA STATE BOARD OF NURSING RN NUMBER | OTHER | AP10558 | 01 | AZ | ARIZONA STATE BOARD OF NURSING NP NUMBER | OTHER |