Individual
TYANNA LEE THOMPSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
4950 S 112TH ST, WALTON, NE 68461-9579
(531) 510-6945
Mailing address
1938 GARFIELD ST, LINCOLN, NE 68502
(531) 519-6945
Taxonomy
Speciality
Code
Description
License number
State
172V00000X
Community Health Worker
Primary
21764579
NE
Other
Enumeration date
12/18/2024
Last updated
12/18/2024
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