MEDICARE: MRS. MELBA LEENE THOMPSON ARNP

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	163W00000X	Registered Nurse	04556321	NH
2	363LA2200X	Adult Health Nurse Practitioner	0455632305	NH

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	0455632305	OTHER	NH	ARNP NH LICENSE NUMBER
2	04556321	OTHER	NH	REGISTERED NURSE NH LICEN

General Provider Information

NPI Number	:	1487756631
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. MELBA LEENE THOMPSON ARNP

Provider Business Mailing Address
First Line	:	125 MAIN ST
Second Line	:	UNIT 49
City	:	NEWMARKET
State	:	NH
Zip	:	03857-1600
Country	:	US
Telephone Number	:	603-659-4747
Fax Number	:

Provider Business Practice Location Address
First Line	:	200 ROUTE 108
Second Line	:
City	:	SOMERSWORTH
State	:	NH
Zip	:	03878-1119
Country	:	US
Telephone Number	:	800-892-8384
Fax Number	:

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

Provider Enumeration Date	:	09/01/2006
Last Update Date	:	07/12/2007

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