Provider Demographics
NPI:1275167686
Name:THOMPSON, ANGELLE BROOKS (CNP)
Entity type:Individual
Prefix:MRS
First Name:ANGELLE
Middle Name:BROOKS
Last Name:THOMPSON
Suffix:
Gender:F
Credentials:CNP
Other - Prefix:
Other - First Name:ANGELLE
Other - Middle Name:AUSET
Other - Last Name:BROOKS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1648 HAMILTON ST
Mailing Address - Street 2:
Mailing Address - City:ALLENTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:18102-5054
Mailing Address - Country:US
Mailing Address - Phone:610-628-8038
Mailing Address - Fax:
Practice Address - Street 1:1648 HAMILTON ST
Practice Address - Street 2:
Practice Address - City:ALLENTOWN
Practice Address - State:PA
Practice Address - Zip Code:18102-5054
Practice Address - Country:US
Practice Address - Phone:610-628-8038
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-02-24
Last Update Date:2025-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASP30778363LF0000X
NC5019834363LF0000X
MN12391363LF0000X
LA209254363LF0000X
TX1104384363LF0000X
TN36211363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA2570714Medicaid
LA209254OtherSTATE LICENSE