Healthcare Provider Details

I. General information

NPI: 1124317987
Provider Name (Legal Business Name): LOC M THOMSON CRNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/01/2011
Last Update Date: 07/29/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2001 MEDICAL PKWY ACUTE CARE PAVILION
ANNAPOLIS MD
21401-3280
US

IV. Provider business mailing address

PO BOX 64916
BALTIMORE MD
21264-4916
US

V. Phone/Fax

Practice location:
  • Phone: 443-481-1000
  • Fax: 410-266-1642
Mailing address:
  • Phone: 443-481-6481
  • Fax: 443-481-6515

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License NumberR151186
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: