Healthcare Provider Details

I. General information

NPI: 1821096512
Provider Name (Legal Business Name): JOAN P THOMPSON CNM
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/07/2005
Last Update Date: 01/24/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

642 ULUKAHIKI ST STE A
KAILUA HI
96734-4400
US

IV. Provider business mailing address

642 ULUKAHIKI ST STE A
KAILUA HI
96734-4400
US

V. Phone/Fax

Practice location:
  • Phone: 808-230-8500
  • Fax: 808-230-8501
Mailing address:
  • Phone: 808-230-8500
  • Fax: 808-230-8501

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367A00000X
TaxonomyAdvanced Practice Midwife
License NumberAPRN-147
License Number StateHI
# 2
Primary TaxonomyN
Taxonomy Code367A00000X
TaxonomyAdvanced Practice Midwife
License NumberRN-36384
License Number StateHI
# 3
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number2003018166
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: