MEDICARE: MS. VENESSA JOAN THOMPSON NP

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	363LW0102X	Women's Health Nurse Practitioner	107667	AZ
2	363LP0808X	Psychiatric/Mental Health Nurse Practitioner	107667	AZ

General Provider Information

NPI Number	:	1801809702
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. VENESSA JOAN THOMPSON NP

Provider Business Mailing Address
First Line	:	11011 S 48TH ST STE 101
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85044-1787
Country	:	US
Telephone Number	:	602-730-9670
Fax Number	:

Provider Business Practice Location Address
First Line	:	11011 S 48TH ST STE 101
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85044-1787
Country	:	US
Telephone Number	:	602-730-9670
Fax Number	:	480-864-9440

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

Provider Enumeration Date	:	08/14/2006
Last Update Date	:	10/18/2024

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