Provider Demographics
NPI:1750875498
Name:THOMPSON, PAULINE D (CNM)
Entity type:Individual
Prefix:
First Name:PAULINE
Middle Name:D
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 1:4604 SPOTSYLVANIA PKWY STE 310
Mailing Address - Street 2:
Mailing Address - City:FREDERICKSBURG
Mailing Address - State:VA
Mailing Address - Zip Code:22408-7766
Mailing Address - Country:US
Mailing Address - Phone:540-710-1700
Mailing Address - Fax:540-710-1800
Practice Address - Street 1:4604 SPOTSYLVANIA PKWY STE 310
Practice Address - Street 2:
Practice Address - City:FREDERICKSBURG
Practice Address - State:VA
Practice Address - Zip Code:22408-7766
Practice Address - Country:US
Practice Address - Phone:540-710-1700
Practice Address - Fax:540-710-1800
Is Sole Proprietor?:No
Enumeration Date:2018-06-16
Last Update Date:2018-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife