Provider Demographics
NPI:1013223213
Name:THOMPSON, MICHELLE M (APRN)
Entity Type:Individual
Prefix:
First Name:MICHELLE
Middle Name:M
Last Name:THOMPSON
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1156 COLUMBUS AVE STE C
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON COURT HOUSE
Mailing Address - State:OH
Mailing Address - Zip Code:43160-2612
Mailing Address - Country:US
Mailing Address - Phone:740-313-7369
Mailing Address - Fax:740-313-7614
Practice Address - Street 1:1156 COLUMBUS AVE STE C
Practice Address - Street 2:
Practice Address - City:WASHINGTON COURT HOUSE
Practice Address - State:OH
Practice Address - Zip Code:43160-2612
Practice Address - Country:US
Practice Address - Phone:740-313-7369
Practice Address - Fax:740-313-7614
Is Sole Proprietor?:No
Enumeration Date:2010-08-25
Last Update Date:2019-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH11595363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily