Provider Demographics
NPI:1609298280
Name:THOMPSON, MARIE NICOLE (CNP)
Entity type:Individual
Prefix:
First Name:MARIE
Middle Name:NICOLE
Last Name:THOMPSON
Suffix:
Gender:F
Credentials:CNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12395 MCCRACKEN RD
Mailing Address - Street 2:
Mailing Address - City:GARFIELD HEIGHTS
Mailing Address - State:OH
Mailing Address - Zip Code:44125-2967
Mailing Address - Country:US
Mailing Address - Phone:216-587-6727
Mailing Address - Fax:216-587-8347
Practice Address - Street 1:12395 MCCRACKEN RD
Practice Address - Street 2:
Practice Address - City:GARFIELD HEIGHTS
Practice Address - State:OH
Practice Address - Zip Code:44125-2967
Practice Address - Country:US
Practice Address - Phone:216-587-6727
Practice Address - Fax:216-587-8347
Is Sole Proprietor?:No
Enumeration Date:2014-01-15
Last Update Date:2017-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHRN 352603 COA1163W00000X
OHCOA 15194-NP163W00000X
OHCOA.15194-NP363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse