Basic Information
| Provider Information | |||||||||
| NPI: | 1932682549 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | THOMPSON | ||||||||
| FirstName: | SHAWNA | ||||||||
| MiddleName: | MARIE | ||||||||
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| Credential: | MSN, APRN, WHNP-BC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 331 PUNCH BOWL ST | ||||||||
| Address2: | |||||||||
| City: | BEAUFORT | ||||||||
| State: | SC | ||||||||
| PostalCode: | 299027517 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9092862836 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 75 BAYLOR DR STE 200 | ||||||||
| Address2: | |||||||||
| City: | BLUFFTON | ||||||||
| State: | SC | ||||||||
| PostalCode: | 299108965 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8435405857 | ||||||||
| FaxNumber: | 8435245655 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/10/2018 | ||||||||
| LastUpdateDate: | 10/15/2018 | ||||||||
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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 | 363LW0102X | 22072 | SC | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Women's Health |
No ID Information.