Provider Demographics
NPI:1760489603
Name:TOMPKINS, MARY M (APRNC CNM)
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:M
Last Name:TOMPKINS
Suffix:
Gender:F
Credentials:APRNC CNM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:3911 AVENUE B
Mailing Address - Street 2:STE 3100
Mailing Address - City:SCOTTSBLUFF
Mailing Address - State:NE
Mailing Address - Zip Code:69361-4617
Mailing Address - Country:US
Mailing Address - Phone:308-635-3033
Mailing Address - Fax:308-635-3010
Practice Address - Street 1:3911 AVENUE B
Practice Address - Street 2:STE 3100
Practice Address - City:SCOTTSBLUFF
Practice Address - State:NE
Practice Address - Zip Code:69361-4617
Practice Address - Country:US
Practice Address - Phone:308-635-3033
Practice Address - Fax:308-635-3010
Is Sole Proprietor?:No
Enumeration Date:2005-07-07
Last Update Date:2007-12-10
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NE120017176B00000X
NE110082363LX0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LX0001XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerObstetrics & Gynecology
No176B00000XOther Service ProvidersMidwife
Provider Identifiers
StateIdentifier IDID TypeIssuer
271721Medicare ID - Type Unspecified