Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LP0808X | Nurse Practitioner - Psychiatric/Mental Health | SP016645 | PA |
NPI | 1013469162 |
---|---|
Provider Name | Tara Thompson |
First Address | Claymont, DE 19703-1711 |
Second Address | Claymont, DE 19703-1711 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 25/10/2016 |
Last Update Date | 25/10/2016 |