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Individual

TAYLOR NICOLE THOMPSON

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
PA-C

Contact information

Practice address
5501 OLD YORK RD, KORMAN BUILDING SUITE 202, PHILADELPHIA, PA 19141-3018
(215) 254-2630
Mailing address
5501 OLD YORK RD, PHILADELPHIA, PA 19141-3018
(215) 254-2630

Taxonomy

Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
Primary
MA057550
PA
363AM0700X
Medical Physician Assistant
PAT0063
MA

Other

Enumeration date
06/18/2014
Last updated
07/02/2015
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