Provider Demographics
NPI:1487867719
Name:THOMPSON, CHARLOTTE WANETTA (APRN-BC, FNP)
Entity Type:Individual
Prefix:
First Name:CHARLOTTE
Middle Name:WANETTA
Last Name:THOMPSON
Suffix:
Gender:F
Credentials:APRN-BC, FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:427 117TH AVE E
Mailing Address - Street 2:
Mailing Address - City:EDGEWOOD
Mailing Address - State:WA
Mailing Address - Zip Code:98372-1276
Mailing Address - Country:US
Mailing Address - Phone:253-952-6649
Mailing Address - Fax:
Practice Address - Street 1:700 15TH ST SW
Practice Address - Street 2:17-67 BLDG, MC 5F-08
Practice Address - City:AUBURN
Practice Address - State:WA
Practice Address - Zip Code:98002
Practice Address - Country:US
Practice Address - Phone:253-931-5842
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAAP0005693363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily