Provider Demographics
NPI:1609471333
Name:THOMPSON, JORENE J
Entity type:Individual
Prefix:
First Name:JORENE
Middle Name:J
Last Name:THOMPSON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 688
Mailing Address - Street 2:
Mailing Address - City:FRUITLAND
Mailing Address - State:NM
Mailing Address - Zip Code:87416-0688
Mailing Address - Country:US
Mailing Address - Phone:505-860-2506
Mailing Address - Fax:
Practice Address - Street 1:6 RD 6896
Practice Address - Street 2:
Practice Address - City:WATERFLOW
Practice Address - State:NM
Practice Address - Zip Code:87421
Practice Address - Country:US
Practice Address - Phone:505-860-2506
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-12-01
Last Update Date:2020-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM3584227800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes227800000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRespiratory Therapist, Certified