Healthcare Provider Details

I. General information

NPI: 1003996273
Provider Name (Legal Business Name): SUZANNE TAYLOR THOMPSON APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/16/2006
Last Update Date: 12/08/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

50 HOSPITAL HILL RD
SHARON CT
06069-2096
US

IV. Provider business mailing address

58 ASHLEY DR
GOSHEN CT
06756-1813
US

V. Phone/Fax

Practice location:
  • Phone: 860-364-0647
  • Fax:
Mailing address:
  • Phone: 860-491-2356
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number002373
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: