MEDICARE: SUSAN DENISE THOMPSON NP-C

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	95004025	CA

General Provider Information

NPI Number	:	1700230133
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SUSAN DENISE THOMPSON NP-C

Provider Business Mailing Address
First Line	:	PO BOX 232410
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92193-2410
Country	:	US
Telephone Number	:	858-249-6749
Fax Number	:

Provider Business Practice Location Address
First Line	:	3530 CAMINO DEL RIO N
Second Line	:	SUITE 107
City	:	SAN DIEGO
State	:	CA
Zip	:	92108-1743
Country	:	US
Telephone Number	:	858-304-6440
Fax Number	:

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

Provider Enumeration Date	:	04/22/2016
Last Update Date	:	06/07/2017

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