Healthcare Provider Details

I. General information

NPI: 1700994712
Provider Name (Legal Business Name): CARRIE M THOMPSON NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: CARRIE M SMITH NP

II. Dates (important events)

Enumeration Date: 08/29/2006
Last Update Date: 03/03/2022
Certification Date: 03/03/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2925 CHICAGO AVE
MINNEAPOLIS MN
55407-1321
US

IV. Provider business mailing address

2925 CHICAGO AVE
MINNEAPOLIS MN
55407-1321
US

V. Phone/Fax

Practice location:
  • Phone: 612-262-7800
  • Fax: 612-262-7022
Mailing address:
  • Phone: 612-262-7800
  • Fax: 612-262-7022

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number146852
License Number StateWI
# 2
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberR 143309-0
License Number StateMN
# 3
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number4331
License Number StateMN
# 4
Primary TaxonomyN
Taxonomy Code363LC1500X
TaxonomyCommunity Health Nurse Practitioner
License Number28193028A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: