Healthcare Provider Details

I. General information

NPI: 1629008289
Provider Name (Legal Business Name): REBECCA J THOMPSON CMW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/03/2006
Last Update Date: 10/17/2020
Certification Date: 10/17/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

70 COHANSEY ST
BRIDGETON NJ
08302-1918
US

IV. Provider business mailing address

103 BEAUREGARD CT
WILMINGTON DE
19810-1181
US

V. Phone/Fax

Practice location:
  • Phone: 856-451-4700
  • Fax: 856-451-0029
Mailing address:
  • Phone: 302-529-7495
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code176B00000X
TaxonomyMidwife
License NumberME00033900
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: