Individual
MR. TYCE ALLEN THOMPSON SR.
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
203 FORT HUACHUCA LN, BISBEE, AZ 85603-3019
(520) 249-6925
Mailing address
PO BOX 4251, BISBEE, AZ 85603-4251
(520) 249-6925
Taxonomy
Speciality
Code
Description
License number
State
376K00000X
Nurse's Aide
CNA25394
FL
376K00000X
Nurse's Aide
Primary
—
AZ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
848955
—
AZ
Enumeration date
01/09/2007
Last updated
07/09/2007
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