Individual
MRS. MERVIANNA THOMPSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
NURSE PRACTITIONER
Contact information
Practice address
1532 CERRILLOS RD STE B, SANTA FE, NM 87505-3512
(059) 824-4255
(505) 982-1263
Mailing address
1035 ALTO ST, SANTA FE, NM 87501-2406
(505) 982-4425
(505) 982-8440
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
CNP-02120
MT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
68971567
—
NM
01
—
TXB106001
MEDICARE PTAN
TX
Enumeration date
10/10/2007
Last updated
05/12/2025
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