=====================================================
General NPI Number Information
=====================================================
NPI Number | 1477384709
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | DANIELLE THOMPSON FNP-BC
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/08/2024
-----------------------------------------------------
Last Update Date | 10/24/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1019 COTTONWOOD DR NW
-----------------------------------------------------
City | LOS RANCHOS
-----------------------------------------------------
State | NM
-----------------------------------------------------
Zip | 87107-6751
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 505-857-3957
-----------------------------------------------------
Fax | 505-447-6767
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1831 CAMINO DEL LLANO
-----------------------------------------------------
City | BELEN
-----------------------------------------------------
State | NM
-----------------------------------------------------
Zip | 87002-2619
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 877-279-5960
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363LF0000X
-----------------------------------------------------
Taxonomy Name | Family Nurse Practitioner
-----------------------------------------------------
License Number | CS02325147
-----------------------------------------------------
License Number State | NM
-----------------------------------------------------