Healthcare Provider Details

I. General information

NPI: 1093345357
Provider Name (Legal Business Name): TAMARA MARGARET THOMPSON APRN CNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/24/2020
Last Update Date: 01/24/2020
Certification Date: 01/24/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2129 OSUNA RD NE
ALBUQUERQUE NM
87113-1002
US

IV. Provider business mailing address

13213 CEDARBROOK AVE NE
ALBUQUERQUE NM
87111-3021
US

V. Phone/Fax

Practice location:
  • Phone: 505-884-4080
  • Fax:
Mailing address:
  • Phone: 505-207-1686
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number59111
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: