Provider Demographics
NPI:1568412922
Name:THOMSON, SHARRON (CNNP)
Entity Type:Individual
Prefix:
First Name:SHARRON
Middle Name:
Last Name:THOMSON
Suffix:
Gender:F
Credentials:CNNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1790 RICHARD CIRCLE
Mailing Address - Street 2:
Mailing Address - City:WEST SAINT PAUL
Mailing Address - State:MN
Mailing Address - Zip Code:55118
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:LAKEVIEW HOSPITAL
Practice Address - Street 2:927 CHURCHILL STREET WEST
Practice Address - City:STILLWATER
Practice Address - State:MN
Practice Address - Zip Code:55082
Practice Address - Country:US
Practice Address - Phone:651-430-8519
Practice Address - Fax:651-220-7777
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-10
Last Update Date:2018-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNTHO1-0430-9896363LN0000X
MNR1624618363LN0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LN0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerNeonatal
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN098485000Medicaid