Deandra Marissah Thompson, PA
Physician Assistant in Fairfield, IL. Individual provider (NPI-1).
NPI number1134877939
StatusActive
Last updated in NPPESMar 11, 2022
Details
- NPI
- 1134877939
- Entity type
- Individual (NPI-1)
- Name
- Deandra Marissah Thompson
- Credential
- PA
- Sex
- Female
- Sole proprietor
- Yes
- Enumeration date
- Mar 11, 2022
- Certification date
- Mar 11, 2022
- Last updated
- Mar 11, 2022
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 363A00000X | Physician Assistant | – | – | Yes |
Practice location
303 Nw 11th StFairfield, IL 62837-1206
Phone 618-842-2611
Mailing address
613 W 12th StFlora, IL 62839-1066
Phone 618-508-3459
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