Provider Demographics
NPI:1174171722
Name:THIBODEAU, SARAH CATHERINE (PA-C)
Entity type:Individual
Prefix:
First Name:SARAH
Middle Name:CATHERINE
Last Name:THIBODEAU
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18761 PRICE ISLAND CIR
Mailing Address - Street 2:
Mailing Address - City:EAGLE RIVER
Mailing Address - State:AK
Mailing Address - Zip Code:99577-8552
Mailing Address - Country:US
Mailing Address - Phone:540-447-4278
Mailing Address - Fax:
Practice Address - Street 1:3719 E MERIDIAN LOOP STE E
Practice Address - Street 2:
Practice Address - City:WASILLA
Practice Address - State:AK
Practice Address - Zip Code:99654-7273
Practice Address - Country:US
Practice Address - Phone:907-671-6017
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-08-27
Last Update Date:2024-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA12247363A00000X
AK191288363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant