Healthcare Provider Details

I. General information

NPI: 1225261019
Provider Name (Legal Business Name): ELIZABETH NIMMICH THOMPSON CRNP-A
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: ELIZABETH NIMMICH KLEIN

II. Dates (important events)

Enumeration Date: 08/27/2009
Last Update Date: 01/31/2022
Certification Date: 01/31/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3700 ODONNELL ST
BALTIMORE MD
21224-5269
US

IV. Provider business mailing address

826 WASHINGTON RD. SUITE 121
WESTMINSTER MD
21157-5779
US

V. Phone/Fax

Practice location:
  • Phone: 773-292-4800
  • Fax: 312-564-4059
Mailing address:
  • Phone: 410-751-2510
  • Fax: 410-751-2515

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License NumberR174104
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: