Provider Demographics
NPI:1518263714
Name:THOMPSON, MARY C (CNM)
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:C
Last Name:THOMPSON
Suffix:
Gender:F
Credentials:CNM
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Mailing Address - Street 1:505 E GRANT ST
Mailing Address - Street 2:SUITE 102
Mailing Address - City:MACOMB
Mailing Address - State:IL
Mailing Address - Zip Code:61455-3352
Mailing Address - Country:US
Mailing Address - Phone:309-833-5959
Mailing Address - Fax:309-833-4969
Practice Address - Street 1:525 E GRANT ST FL 3
Practice Address - Street 2:
Practice Address - City:MACOMB
Practice Address - State:IL
Practice Address - Zip Code:61455-3313
Practice Address - Country:US
Practice Address - Phone:309-836-6937
Practice Address - Fax:309-836-6530
Is Sole Proprietor?:No
Enumeration Date:2011-02-04
Last Update Date:2023-04-06
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IL209008619367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife