Provider Demographics
NPI:1164436937
Name:THOMPSON, DEIRDRE C (CNM)
Entity Type:Individual
Prefix:MS
First Name:DEIRDRE
Middle Name:C
Last Name:THOMPSON
Suffix:
Gender:F
Credentials:CNM
Other - Prefix:MRS
Other - First Name:DEIRDRE
Other - Middle Name:C
Other - Last Name:PASCHETTO
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:4900 S MONACO ST
Mailing Address - Street 2:SUITE 210
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80237-3486
Mailing Address - Country:US
Mailing Address - Phone:303-873-5245
Mailing Address - Fax:303-873-5240
Practice Address - Street 1:1400 S. POTOMAC ST
Practice Address - Street 2:#225
Practice Address - City:AURORA
Practice Address - State:CO
Practice Address - Zip Code:80012-4514
Practice Address - Country:US
Practice Address - Phone:303-873-5245
Practice Address - Fax:303-873-5240
Is Sole Proprietor?:No
Enumeration Date:2006-07-28
Last Update Date:2013-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO5031367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO86208322Medicaid
CO811064Medicare PIN
CO86208322Medicaid
COCOA106809Medicare PIN
COC810265Medicare PIN