MEDICARE: MRS. SUSAN D THOMPSON APRN, FNP-C

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LF0000X	Family Nurse Practitioner	209021510	IL
2	364SA2200X	Adult Health Clinical Nurse Specialist	277000968	IL
3	363LF0000X	Family Nurse Practitioner	277001937	IL

General Provider Information

NPI Number	:	1164771242
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. SUSAN D THOMPSON APRN, FNP-C

Provider Business Mailing Address
First Line	:	20015 N LAGRANGE RD
Second Line	:
City	:	FRANKFORT
State	:	IL
Zip	:	60423-3104
Country	:	US
Telephone Number	:	815-649-1910
Fax Number	:

Provider Business Practice Location Address
First Line	:	20015 N LAGRANGE RD
Second Line	:
City	:	FRANKFORT
State	:	IL
Zip	:	60423-3104
Country	:	US
Telephone Number	:	815-649-1910
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/05/2012
Last Update Date	:	09/02/2024

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