1225261019 NPI number — ELIZABETH NIMMICH THOMPSON CRNP-A

Table of content: ELIZABETH NIMMICH THOMPSON CRNP-A (NPI 1225261019)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1225261019 NPI number — ELIZABETH NIMMICH THOMPSON CRNP-A

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
THOMPSON
Provider First Name:
ELIZABETH
Provider Middle Name:
NIMMICH
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
CRNP-A
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
KLEIN
Provider Other First Name:
ELIZABETH
Provider Other Middle Name:
NIMMICH
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1225261019
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
01/31/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
826 WASHINGTON RD.
Provider Second Line Business Mailing Address:
SUITE 121
Provider Business Mailing Address City Name:
WESTMINSTER
Provider Business Mailing Address State Name:
MD
Provider Business Mailing Address Postal Code:
21157-5779
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
410-751-2510
Provider Business Mailing Address Fax Number:
410-751-2515

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3700 ODONNELL ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BALTIMORE
Provider Business Practice Location Address State Name:
MD
Provider Business Practice Location Address Postal Code:
21224-5269
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
773-292-4800
Provider Business Practice Location Address Fax Number:
312-564-4059
Provider Enumeration Date:
08/27/2009

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 363LA2200X , with the licence number:  R174104 , registered in the state of MD ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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