Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 363L00000X | Nurse Practitioner | 0001226832 | VA |
Y | 363LA2100X | Nurse Practitioner - Acute Care | 0001226832 | VA |
NPI | 1023511540 |
---|---|
Provider Name | Shannon Leigh Thompson |
First Address | Richmond, VA 23291-1734 |
Second Address | Richmond, VA 23298-5051 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 11/03/2018 |
Last Update Date | 28/09/2021 |