Healthcare Provider Details

I. General information

NPI: 1477384709
Provider Name (Legal Business Name): DANIELLE THOMPSON FNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/08/2024
Last Update Date: 10/24/2025
Certification Date: 10/24/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1019 COTTONWOOD DR NW
LOS RANCHOS NM
87107-6751
US

IV. Provider business mailing address

1831 CAMINO DEL LLANO
BELEN NM
87002-2619
US

V. Phone/Fax

Practice location:
  • Phone: 505-857-3957
  • Fax: 505-447-6767
Mailing address:
  • Phone: 877-279-5960
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberCS02325147
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: