Provider Demographics
NPI:1275596934
Name:THOMPSON, ANN M (CNM (RETIRED))
Entity Type:Individual
Prefix:
First Name:ANN
Middle Name:M
Last Name:THOMPSON
Suffix:
Gender:F
Credentials:CNM (RETIRED)
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1850 E PARK AVE
Mailing Address - Street 2:SUITE 301
Mailing Address - City:STATE COLLEGE
Mailing Address - State:PA
Mailing Address - Zip Code:16803-6706
Mailing Address - Country:US
Mailing Address - Phone:814-237-3470
Mailing Address - Fax:814-237-2035
Practice Address - Street 1:1850 E PARK AVE
Practice Address - Street 2:SUITE 301
Practice Address - City:STATE COLLEGE
Practice Address - State:PA
Practice Address - Zip Code:16803-6706
Practice Address - Country:US
Practice Address - Phone:814-237-3470
Practice Address - Fax:814-237-2035
Is Sole Proprietor?:No
Enumeration Date:2006-04-11
Last Update Date:2008-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMW008370L367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAR09043Medicare UPIN