Healthcare Provider Details

I. General information

NPI: 1821166901
Provider Name (Legal Business Name): NANCY THOMPSON CNS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/30/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1160 RAYMOND BLVD 5TH FLOOR
NEWARK NJ
07102-4168
US

IV. Provider business mailing address

12 SHEPHERDS LN
WHITEHOUSE STATION NJ
08889-3140
US

V. Phone/Fax

Practice location:
  • Phone: 973-596-3952
  • Fax:
Mailing address:
  • Phone: 908-534-9635
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WP0808X
TaxonomyPsychiatric/Mental Health Registered Nurse
License Number26NC05513200
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: