Provider Demographics
NPI:1902300205
Name:THOMPSON, SANDRA RAE (MSN, APNP, FNP-C)
Entity type:Individual
Prefix:MRS
First Name:SANDRA
Middle Name:RAE
Last Name:THOMPSON
Suffix:
Gender:F
Credentials:MSN, APNP, FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5395 E CHERYL PKWY
Mailing Address - Street 2:
Mailing Address - City:FITCHBURG
Mailing Address - State:WI
Mailing Address - Zip Code:53711-5395
Mailing Address - Country:US
Mailing Address - Phone:608-276-4660
Mailing Address - Fax:608-276-4672
Practice Address - Street 1:5395 E CHERYL PKWY
Practice Address - Street 2:
Practice Address - City:FITCHBURG
Practice Address - State:WI
Practice Address - Zip Code:53711-5395
Practice Address - Country:US
Practice Address - Phone:608-276-4660
Practice Address - Fax:608-276-4672
Is Sole Proprietor?:No
Enumeration Date:2018-03-21
Last Update Date:2018-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI189406-30163W00000X
IL041.452688163W00000X
IN28185998A163W00000X
WI8283-33363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse