Healthcare Provider Details

I. General information

NPI: 1598869943
Provider Name (Legal Business Name): MARTHA D THOMPSON CNM
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/07/2006
Last Update Date: 03/03/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

500 HELENDALE RD
ROCHESTER NY
14609-3173
US

IV. Provider business mailing address

50 HELENDALE
ROCHESTER NY
14609-3038
US

V. Phone/Fax

Practice location:
  • Phone: 585-266-1220
  • Fax: 585-266-1227
Mailing address:
  • Phone: 585-266-1220
  • Fax: 585-266-1227

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367A00000X
TaxonomyAdvanced Practice Midwife
License Number001050
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: