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General NPI Number Information
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NPI Number | 1639891013
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Entity Type | Individual
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Provider Name | BIANCA SHANE' THOMPSON MSN, CNM
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Gender | Female
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Dates
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Enumeration Date | 09/13/2022
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Last Update Date | 09/13/2022
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Provider Practice Location Address
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Address Line | 4200A TECHNOLOGY CT
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City | CHANTILLY
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State | VA
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Zip | 20151-1214
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Country | US
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Telephone | 540-709-1737
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Fax |
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Provider Business Mailing Address
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Address Line | 15200 LEICESTERSHIRE ST UNIT 441
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City | WOODBRIDGE
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State | VA
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Zip | 22191-5945
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Country | US
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Telephone | 571-247-7158
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 367A00000X
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Taxonomy Name | Advanced Practice Midwife
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License Number | CNM07386
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License Number State | VA
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