Provider Demographics
NPI:1295187607
Name:THOMPSON, GENEVIEVE (RN, CDE)
Entity type:Individual
Prefix:
First Name:GENEVIEVE
Middle Name:
Last Name:THOMPSON
Suffix:
Gender:F
Credentials:RN, CDE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14 FULTON DR
Mailing Address - Street 2:
Mailing Address - City:STAFFORD
Mailing Address - State:VA
Mailing Address - Zip Code:22554-7827
Mailing Address - Country:US
Mailing Address - Phone:540-538-1538
Mailing Address - Fax:
Practice Address - Street 1:14 FULTON DR
Practice Address - Street 2:
Practice Address - City:STAFFORD
Practice Address - State:VA
Practice Address - Zip Code:22554-7827
Practice Address - Country:US
Practice Address - Phone:540-538-1538
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-07-09
Last Update Date:2016-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0001163748163WC0400X, 163WD0400X, 163WN1003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WD0400XNursing Service ProvidersRegistered NurseDiabetes Educator
No163WC0400XNursing Service ProvidersRegistered NurseCase Management
No163WN1003XNursing Service ProvidersRegistered NurseNutrition Support