Provider Demographics
NPI:1093788598
Name:THOMPSON, SUSAN J (NP)
Entity Type:Individual
Prefix:
First Name:SUSAN
Middle Name:J
Last Name:THOMPSON
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:7124 COMMONS DR
Mailing Address - Street 2:SUITE C
Mailing Address - City:CHEYENNE
Mailing Address - State:WY
Mailing Address - Zip Code:82009-2620
Mailing Address - Country:US
Mailing Address - Phone:307-426-4060
Mailing Address - Fax:307-426-4061
Practice Address - Street 1:7124 COMMONS DR
Practice Address - Street 2:SUITE C
Practice Address - City:CHEYENNE
Practice Address - State:WY
Practice Address - Zip Code:82009-2620
Practice Address - Country:US
Practice Address - Phone:307-426-4060
Practice Address - Fax:307-426-4061
Is Sole Proprietor?:No
Enumeration Date:2006-02-07
Last Update Date:2015-03-03
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
WY18209.0373363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
WY21316Medicare PIN