Basic Information
| Provider Information | |||||||||
| NPI: | 1316312788 | ||||||||
| EntityType: | 1 | ||||||||
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| LastName: | THOMPSON | ||||||||
| FirstName: | JENNIFER | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1301 TRUMANSBURG RD STE L | ||||||||
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| City: | ITHACA | ||||||||
| State: | NY | ||||||||
| PostalCode: | 148501397 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2152557822 | ||||||||
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| Practice Location | |||||||||
| Address1: | 1427 VINE ST | ||||||||
| Address2: | 2ND FLOOR | ||||||||
| City: | PHILADELPHIA | ||||||||
| State: | PA | ||||||||
| PostalCode: | 191021031 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2157621838 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 12/10/2015 | ||||||||
| LastUpdateDate: | 10/01/2019 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 367A00000X | MW010386 | PA | N | Physician Assistants & Advanced Practice Nursing Providers | Advanced Practice Midwife | 363LX0001X | F421384 | NY | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Obstetrics & Gynecology |
No ID Information.