Provider Demographics
NPI:1861938508
Name:THOMPSON, JACE EUGENE (LVN)
Entity type:Individual
Prefix:MR
First Name:JACE
Middle Name:EUGENE
Last Name:THOMPSON
Suffix:
Gender:M
Credentials:LVN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:410 WINDFIELDS WAY
Mailing Address - Street 2:
Mailing Address - City:BEAUMONT
Mailing Address - State:CA
Mailing Address - Zip Code:92223-7011
Mailing Address - Country:US
Mailing Address - Phone:951-259-8659
Mailing Address - Fax:
Practice Address - Street 1:410 WINDFIELDS WAY
Practice Address - Street 2:
Practice Address - City:BEAUMONT
Practice Address - State:CA
Practice Address - Zip Code:92223-7011
Practice Address - Country:US
Practice Address - Phone:951-259-8659
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-01-18
Last Update Date:2017-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA283285164X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164X00000XNursing Service ProvidersLicensed Vocational Nurse