Provider Demographics
NPI:1558474023
Name:THOMPSON, PATRICK (NP)
Entity Type:Individual
Prefix:MR
First Name:PATRICK
Middle Name:
Last Name:THOMPSON
Suffix:
Gender:M
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:250 BON AIR RD
Mailing Address - Street 2:CMHS
Mailing Address - City:GREENBRAE
Mailing Address - State:CA
Mailing Address - Zip Code:94904-1702
Mailing Address - Country:US
Mailing Address - Phone:415-473-2961
Mailing Address - Fax:415-507-4113
Practice Address - Street 1:250 BON AIR RD
Practice Address - Street 2:CMHS
Practice Address - City:GREENBRAE
Practice Address - State:CA
Practice Address - Zip Code:94904-1702
Practice Address - Country:US
Practice Address - Phone:415-507-2961
Practice Address - Fax:415-507-4113
Is Sole Proprietor?:No
Enumeration Date:2006-08-17
Last Update Date:2011-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA503711363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAZZZ05058ZOtherPTAN