Provider Demographics
NPI:1831951557
Name:CHRISTEN THOMPSON, MARISSA (CRNP)
Entity type:Individual
Prefix:
First Name:MARISSA
Middle Name:
Last Name:CHRISTEN THOMPSON
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:MARISSA
Other - Middle Name:
Other - Last Name:CHRISTEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:211 HEWETT RD
Mailing Address - Street 2:
Mailing Address - City:WYNCOTE
Mailing Address - State:PA
Mailing Address - Zip Code:19095-1203
Mailing Address - Country:US
Mailing Address - Phone:845-240-2013
Mailing Address - Fax:
Practice Address - Street 1:2401 W CHELTENHAM AVE
Practice Address - Street 2:
Practice Address - City:WYNCOTE
Practice Address - State:PA
Practice Address - Zip Code:19095-2946
Practice Address - Country:US
Practice Address - Phone:267-532-9931
Practice Address - Fax:215-695-2935
Is Sole Proprietor?:No
Enumeration Date:2024-01-29
Last Update Date:2024-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARN709060163W00000X
PASP029140363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse