Individual
MITZI B THOMPSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
NP
Contact information
Practice address
2460 NW STEWART PARKWAY, SUITE 104, ROSEBURG, OR 97471-1516
(541) 677-4463
(541) 677-3379
Mailing address
2460 NW STEWART PKWY, STE 240, ROSEBURG, OR 97471-1516
(541) 677-6111
(541) 677-6140
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
RN0000055333
TN
363LW0102X
Women's Health Nurse Practitioner
Primary
201505556NP-PP
OR
363LW0102X
Women's Health Nurse Practitioner
APN 0000005657
TN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
3905311
MEDICARE-TENNCARE
TN
05
—
3905311
—
TN
05
—
500695863
—
OR
Enumeration date
01/18/2006
Last updated
02/03/2020
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