Provider Demographics
NPI:1821096512
Name:THOMPSON, JOAN P (CNM)
Entity Type:Individual
Prefix:MS
First Name:JOAN
Middle Name:P
Last Name:THOMPSON
Suffix:
Gender:F
Credentials:CNM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:642 ULUKAHIKI ST
Mailing Address - Street 2:STE A
Mailing Address - City:KAILUA
Mailing Address - State:HI
Mailing Address - Zip Code:96734-4400
Mailing Address - Country:US
Mailing Address - Phone:808-230-8500
Mailing Address - Fax:808-230-8501
Practice Address - Street 1:642 ULUKAHIKI ST
Practice Address - Street 2:STE A
Practice Address - City:KAILUA
Practice Address - State:HI
Practice Address - Zip Code:96734-4400
Practice Address - Country:US
Practice Address - Phone:808-230-8500
Practice Address - Fax:808-230-8501
Is Sole Proprietor?:No
Enumeration Date:2005-07-07
Last Update Date:2012-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIAPRN-147367A00000X
HIRN-36384367A00000X
MO2003018166163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO259136406Medicaid
P95039Medicare UPIN
MO259136406Medicaid