Provider Demographics
NPI:1457981615
Name:THOMPSON, NICOLE MARIE (NP)
Entity type:Individual
Prefix:
First Name:NICOLE
Middle Name:MARIE
Last Name:THOMPSON
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:300 S STRATFORD AVE
Mailing Address - Street 2:
Mailing Address - City:SANTA MARIA
Mailing Address - State:CA
Mailing Address - Zip Code:93454-5903
Mailing Address - Country:US
Mailing Address - Phone:805-739-3863
Mailing Address - Fax:805-614-2035
Practice Address - Street 1:300 S STRATFORD AVE
Practice Address - Street 2:
Practice Address - City:SANTA MARIA
Practice Address - State:CA
Practice Address - Zip Code:93454-5903
Practice Address - Country:US
Practice Address - Phone:805-332-8181
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-01-16
Last Update Date:2023-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95013691207T00000X, 363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No207T00000XAllopathic & Osteopathic PhysiciansNeurological Surgery