Healthcare Provider Details

I. General information

NPI: 1285148833
Provider Name (Legal Business Name): ANNIE THOMPSON CNM
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/17/2017
Last Update Date: 08/19/2021
Certification Date: 08/19/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1248 HUFFMAN MILL RD STE 101
BURLINGTON NC
27215-8700
US

IV. Provider business mailing address

1248 HUFFMAN MILL RD STE 101
BURLINGTON NC
27215-8700
US

V. Phone/Fax

Practice location:
  • Phone: 336-538-0089
  • Fax: 336-538-0097
Mailing address:
  • Phone: 336-538-0089
  • Fax: 336-538-0097

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number205053
License Number StateNC
# 2
Primary TaxonomyN
Taxonomy Code176B00000X
TaxonomyMidwife
License Number668
License Number StateNC
# 3
Primary TaxonomyY
Taxonomy Code367A00000X
TaxonomyAdvanced Practice Midwife
License Number668
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: