Basic Information
| Provider Information | |||||||||
| NPI: | 1780295980 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | THOMPSON | ||||||||
| FirstName: | ELIZA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 602 E NOB HILL BLVD | ||||||||
| Address2: | |||||||||
| City: | YAKIMA | ||||||||
| State: | WA | ||||||||
| PostalCode: | 989013534 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5092483334 | ||||||||
| FaxNumber: | 5094536144 | ||||||||
| Practice Location | |||||||||
| Address1: | 602 E NOB HILL BLVD | ||||||||
| Address2: | |||||||||
| City: | YAKIMA | ||||||||
| State: | WA | ||||||||
| PostalCode: | 989013534 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5095753399 | ||||||||
| FaxNumber: | 5094536144 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/11/2020 | ||||||||
| LastUpdateDate: | 08/27/2020 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 08/27/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | RN61084245 | WA | N | Allopathic & Osteopathic Physicians | Family Medicine | 363LF0000X | 390200000X | WA | N | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family | 207Q00000X | AP61084248 | WA | Y | Allopathic & Osteopathic Physicians | Family Medicine |
ID Information
| ID | Type | State | Issuer | Description | 390200000X | 01 | YAKIMA CLINIC | OTHER |