Basic Information
| Provider Information | |||||||||
| NPI: | 1134654361 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | THOMPSON | ||||||||
| FirstName: | SUSAN | ||||||||
| MiddleName: | PRESCOTT | ||||||||
| NamePrefix: | |||||||||
| NameSuffix: | |||||||||
| Credential: | CRNP | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | THOMPSON | ||||||||
| OtherFirstName: | SCOTTIE | ||||||||
| OtherMiddleName: | |||||||||
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| OtherCredential: | CRNP | ||||||||
| OtherLastNameType: | 5 | ||||||||
| Mailing Information | |||||||||
| Address1: | 250 KING OF PRUSSIA RD | ||||||||
| Address2: | |||||||||
| City: | RADNOR | ||||||||
| State: | PA | ||||||||
| PostalCode: | 190875235 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6109022450 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 250 KING OF PRUSSIA RD | ||||||||
| Address2: | SUITE 2J | ||||||||
| City: | RADNOR | ||||||||
| State: | PA | ||||||||
| PostalCode: | 190875235 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6109022450 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/25/2017 | ||||||||
| LastUpdateDate: | 07/21/2022 | ||||||||
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| NPIReactivationDate: | |||||||||
| ProviderGenderCode: | F | ||||||||
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| AuthorizedOfficialMiddleName: | |||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LF0000X | SP017371 | PA | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family |
No ID Information.