MEDICARE: BETH ANN THOMPSON NURSE PRACTITIONER

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LF0000X	Family Nurse Practitioner	277.002784	IL

General Provider Information

NPI Number	:	1386011252
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BETH ANN THOMPSON NURSE PRACTITIONER

Provider Business Mailing Address
First Line	:	3413 COLONY BAY DR
Second Line	:
City	:	ROCKFORD
State	:	IL
Zip	:	61109-2560
Country	:	US
Telephone Number	:	779-368-0757
Fax Number	:

Provider Business Practice Location Address
First Line	:	3413 COLONY BAY DR
Second Line	:
City	:	ROCKFORD
State	:	IL
Zip	:	61109-2560
Country	:	US
Telephone Number	:	779-368-0757
Fax Number	:	779-368-0758

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/27/2015
Last Update Date	:	11/15/2023

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