Provider Demographics
NPI:1013037886
Name:THOMPSON, ANGELA C (NP)
Entity Type:Individual
Prefix:
First Name:ANGELA
Middle Name:C
Last Name:THOMPSON
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:ANGIE
Other - Middle Name:
Other - Last Name:THOMPSON
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:132 E 360 N
Mailing Address - Street 2:
Mailing Address - City:PROVIDENCE
Mailing Address - State:UT
Mailing Address - Zip Code:84332-9650
Mailing Address - Country:US
Mailing Address - Phone:435-799-3840
Mailing Address - Fax:833-205-1005
Practice Address - Street 1:411 W 100 N UNIT 412
Practice Address - Street 2:
Practice Address - City:PROVIDENCE
Practice Address - State:UT
Practice Address - Zip Code:84332-6418
Practice Address - Country:US
Practice Address - Phone:435-799-3840
Practice Address - Fax:833-205-1005
Is Sole Proprietor?:No
Enumeration Date:2007-03-29
Last Update Date:2024-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT5083146-4405363LW0102X
WAAP 60546946363LW0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health