Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LW0102X | Nurse Practitioner - Women's Health | 5083146-4405 | UT |
N | 363LW0102X | Nurse Practitioner - Women's Health | AP 60546946 | WA |
NPI | 1013037886 |
---|---|
Provider Name | Angela C Thompson |
First Address | Providence, UT 84332-9650 |
Second Address | Providence, UT 84332-9803 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 29/03/2007 |
Last Update Date | 13/05/2020 |