Provider Demographics
NPI:1972931640
Name:THOMSON, MANJU (MSN CPNP)
Entity type:Individual
Prefix:MRS
First Name:MANJU
Middle Name:
Last Name:THOMSON
Suffix:
Gender:F
Credentials:MSN CPNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:25810 N 50TH GLN
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85083-1848
Mailing Address - Country:US
Mailing Address - Phone:623-251-5115
Mailing Address - Fax:623-362-8095
Practice Address - Street 1:4540 E BASELINE RD STE 108
Practice Address - Street 2:
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85206-4616
Practice Address - Country:US
Practice Address - Phone:480-892-3880
Practice Address - Fax:480-545-4551
Is Sole Proprietor?:No
Enumeration Date:2013-10-16
Last Update Date:2023-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZAP5226363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics