Healthcare Provider Details

I. General information

NPI: 1609298280
Provider Name (Legal Business Name): MARIE NICOLE THOMPSON CNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/15/2014
Last Update Date: 11/04/2025
Certification Date: 11/04/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

109 W 27TH ST RM 5S
NEW YORK NY
10001-6208
US

IV. Provider business mailing address

12395 MCCRACKEN RD
GARFIELD HEIGHTS OH
44125-2967
US

V. Phone/Fax

Practice location:
  • Phone: 833-351-8255
  • Fax: 888-815-3583
Mailing address:
  • Phone: 216-587-6727
  • Fax: 216-587-8347

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberCOA.15194-NP
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberCOA 15194-NP
License Number StateOH
# 3
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN 352603 COA1
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: