Provider Demographics
NPI:1629112354
Name:THOMPSON, NADINE SETONA (PA)
Entity Type:Individual
Prefix:
First Name:NADINE
Middle Name:SETONA
Last Name:THOMPSON
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:NADINE
Other - Middle Name:SETONA
Other - Last Name:GARTNER THOMPSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:21420 DAVIS MILL RD
Mailing Address - Street 2:
Mailing Address - City:GERMANTOWN
Mailing Address - State:MD
Mailing Address - Zip Code:20876-4422
Mailing Address - Country:US
Mailing Address - Phone:301-916-4377
Mailing Address - Fax:512-681-7874
Practice Address - Street 1:6301 EXECUTIVE BLVD
Practice Address - Street 2:
Practice Address - City:ROCKVILLE
Practice Address - State:MD
Practice Address - Zip Code:20852-3905
Practice Address - Country:US
Practice Address - Phone:301-770-4967
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-16
Last Update Date:2017-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDC01723363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical