Basic Information
Provider Information
NPI: 1548499460
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: THOMPSON
FirstName: LUCIA
MiddleName:  
NamePrefix:  
NameSuffix:  
Credential: FNP
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 2100 POWELL ST
Address2: STE 900
City: EMERYVILLE
State: CA
PostalCode: 946081826
CountryCode: US
TelephoneNumber: 5103502600
FaxNumber:  
Practice Location
Address1: 450 GREENFIELD AVE
Address2:  
City: HANFORD
State: CA
PostalCode: 932303513
CountryCode: US
TelephoneNumber: 5595829000
FaxNumber:  
Other Information
ProviderEnumerationDate: 07/13/2009
LastUpdateDate: 07/13/2009
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
363LF0000XRN584057CAY Physician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily

No ID Information.


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