Provider Demographics
NPI:1700454220
Name:THOMPSON, ELAINE MARY (DNP, CNM, FNP-BC)
Entity Type:Individual
Prefix:MS
First Name:ELAINE
Middle Name:MARY
Last Name:THOMPSON
Suffix:
Gender:F
Credentials:DNP, CNM, FNP-BC
Other - Prefix:
Other - First Name:ELAINE
Other - Middle Name:MARY
Other - Last Name:MCCORMICK
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:11021 E 16000 N
Mailing Address - Street 2:
Mailing Address - City:MOUNT PLEASANT
Mailing Address - State:UT
Mailing Address - Zip Code:84647-5651
Mailing Address - Country:US
Mailing Address - Phone:801-367-6296
Mailing Address - Fax:
Practice Address - Street 1:1100 S MEDICAL DR
Practice Address - Street 2:
Practice Address - City:MOUNT PLEASANT
Practice Address - State:UT
Practice Address - Zip Code:84647-2222
Practice Address - Country:US
Practice Address - Phone:435-462-3471
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-06-11
Last Update Date:2023-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT500988-3102163W00000X
UT500988-4402367A00000X
UT500988-4405363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife
No163W00000XNursing Service ProvidersRegistered Nurse
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily