Healthcare Provider Details

I. General information

NPI: 1720711765
Provider Name (Legal Business Name): JOANNE MARY THOMPSON NNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/07/2022
Last Update Date: 09/23/2025
Certification Date: 09/23/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3901 BEAUBIEN ST
DETROIT MI
48201-2119
US

IV. Provider business mailing address

1105 SIXTH ST
TRAVERSE CITY MI
49684-2345
US

V. Phone/Fax

Practice location:
  • Phone: 313-745-5870
  • Fax:
Mailing address:
  • Phone: 231-935-6250
  • Fax: 231-935-8357

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LN0000X
TaxonomyNeonatal Nurse Practitioner
License Number4704307700
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: