Provider Demographics
NPI:1477546919
Name:THOMPSON, JANE QUINAN (NP)
Entity Type:Individual
Prefix:
First Name:JANE
Middle Name:QUINAN
Last Name:THOMPSON
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:JANE
Other - Middle Name:MARIE
Other - Last Name:QUINAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1830 TOWN CENTER DRIVE
Mailing Address - Street 2:SUITE 205
Mailing Address - City:RESTON
Mailing Address - State:VA
Mailing Address - Zip Code:20190-3236
Mailing Address - Country:US
Mailing Address - Phone:703-435-3636
Mailing Address - Fax:703-435-8145
Practice Address - Street 1:1830 TOWN CENTER DRIVE
Practice Address - Street 2:SUITE 205
Practice Address - City:RESTON
Practice Address - State:VA
Practice Address - Zip Code:20190-3236
Practice Address - Country:US
Practice Address - Phone:703-723-7337
Practice Address - Fax:703-723-6848
Is Sole Proprietor?:No
Enumeration Date:2005-08-30
Last Update Date:2014-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0024165977363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA010055717Medicaid
VA003794L19Medicare ID - Type Unspecified
Q08036Medicare UPIN