Basic Information
| Provider Information | |||||||||
| NPI: | 1245514348 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | THOMPSON | ||||||||
| FirstName: | BRADLEY | ||||||||
| MiddleName: | REGAN | ||||||||
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| Credential: | R.N. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3702 S 7TH ST | ||||||||
| Address2: | APT. B | ||||||||
| City: | TACOMA | ||||||||
| State: | WA | ||||||||
| PostalCode: | 984052104 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2066015442 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 4301 S PINE ST | ||||||||
| Address2: | SUITE 301 | ||||||||
| City: | TACOMA | ||||||||
| State: | WA | ||||||||
| PostalCode: | 984097264 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2534766500 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 10/06/2011 | ||||||||
| LastUpdateDate: | 10/06/2011 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 163W00000X | RN60113449 | WA | Y | Nursing Service Providers | Registered Nurse |
No ID Information.