Individual
DEANDRA MARISSAH THOMPSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PA
Contact information
Practice address
303 NW 11TH ST, FAIRFIELD, IL 62837-1206
(618) 842-2611
Mailing address
613 W 12TH ST, FLORA, IL 62839-1066
(618) 508-3459
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
—
—
Other
Enumeration date
03/11/2022
Last updated
03/11/2022
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