Provider Demographics
NPI:1467615476
Name:THOMPSON, DONNA M (APRN BC)
Entity Type:Individual
Prefix:MRS
First Name:DONNA
Middle Name:M
Last Name:THOMPSON
Suffix:
Gender:F
Credentials:APRN BC
Other - Prefix:MISS
Other - First Name:DONNA
Other - Middle Name:J
Other - Last Name:MASON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:FNP
Mailing Address - Street 1:2639 SKYLINE DRIVE
Mailing Address - Street 2:
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84108
Mailing Address - Country:US
Mailing Address - Phone:801-598-7085
Mailing Address - Fax:801-582-7684
Practice Address - Street 1:2639 SKYLINE DRIVE
Practice Address - Street 2:
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84108
Practice Address - Country:US
Practice Address - Phone:801-598-7085
Practice Address - Fax:801-582-7684
Is Sole Proprietor?:Yes
Enumeration Date:2008-07-09
Last Update Date:2008-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT2012304405363L00000X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily