Healthcare Provider Details

I. General information

NPI: 1164079828
Provider Name (Legal Business Name): IVY ELIZABETH THOMPSON FNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: MRS. IVY ELIZABETH REGISTER

II. Dates (important events)

Enumeration Date: 08/19/2019
Last Update Date: 05/14/2025
Certification Date: 05/14/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

800 N DUPONT BLVD
MILFORD DE
19963-1019
US

IV. Provider business mailing address

800 N DUPONT BLVD
MILFORD DE
19963-1019
US

V. Phone/Fax

Practice location:
  • Phone: 302-430-5705
  • Fax: 302-430-5679
Mailing address:
  • Phone: 302-450-3481
  • Fax: 302-430-5679

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number104266
License Number StateWV
# 2
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberLG-0012661
License Number StateDE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: