Healthcare Provider Details

I. General information

NPI: 1811185333
Provider Name (Legal Business Name): MERVIANNA THOMPSON NURSE PRACTITIONER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/10/2007
Last Update Date: 05/12/2025
Certification Date: 05/12/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1532 CERRILLOS RD STE B
SANTA FE NM
87505-3512
US

IV. Provider business mailing address

1035 ALTO ST
SANTA FE NM
87501-2406
US

V. Phone/Fax

Practice location:
  • Phone: 59-824-4255
  • Fax: 505-982-1263
Mailing address:
  • Phone: 505-982-4425
  • Fax: 505-982-8440

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberCNP-02120
License Number StateMT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: