Provider Demographics
NPI:1952475394
Name:THOMPSON, CASANDRA L (CNM, ARNP)
Entity Type:Individual
Prefix:
First Name:CASANDRA
Middle Name:L
Last Name:THOMPSON
Suffix:
Gender:F
Credentials:CNM, ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2319 SW 320TH ST
Mailing Address - Street 2:
Mailing Address - City:FEDERAL WAY
Mailing Address - State:WA
Mailing Address - Zip Code:98023-2514
Mailing Address - Country:US
Mailing Address - Phone:253-927-5053
Mailing Address - Fax:253-927-6911
Practice Address - Street 1:2319 SW 320TH ST
Practice Address - Street 2:
Practice Address - City:FEDERAL WAY
Practice Address - State:WA
Practice Address - Zip Code:98023-2514
Practice Address - Country:US
Practice Address - Phone:253-927-5053
Practice Address - Fax:253-927-6911
Is Sole Proprietor?:No
Enumeration Date:2006-11-18
Last Update Date:2011-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAAP30006290367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife
Provider Identifiers
StateIdentifier IDID TypeIssuer
CNM # 10985OtherACNM NATIONAL CERT.
WA9635038Medicaid
WAAP 300006290OtherARNP
CNM # 10985OtherACNM NATIONAL CERT.
WAGAB40018Medicare PIN