Individual
PENNY L THOMPSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
NP
Contact information
Practice address
9751 E GRAND RIVER AVE, PORTLAND, MI 48875-9774
(517) 647-6722
(517) 647-6838
Mailing address
PO BOX 13008, LANSING, MI 48901-3008
(517) 253-6320
(517) 253-6321
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
4704141434
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
4579202
—
MI
Enumeration date
07/04/2006
Last updated
08/24/2023
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