Provider Demographics
NPI:1134132582
Name:THOMPSON, SARA B (APRN-C)
Entity Type:Individual
Prefix:
First Name:SARA
Middle Name:B
Last Name:THOMPSON
Suffix:
Gender:F
Credentials:APRN-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:28 BROOKDALE AVE
Mailing Address - Street 2:
Mailing Address - City:VERONA
Mailing Address - State:NJ
Mailing Address - Zip Code:07044-2430
Mailing Address - Country:US
Mailing Address - Phone:973-571-0630
Mailing Address - Fax:
Practice Address - Street 1:28 BROOKDALE AVE
Practice Address - Street 2:
Practice Address - City:VERONA
Practice Address - State:NJ
Practice Address - Zip Code:07044-2430
Practice Address - Country:US
Practice Address - Phone:973-571-0630
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJNN51742363LG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology