Provider Demographics
NPI:1346301967
Name:THIBAULT, CHERYL RENEE (FNPC)
Entity Type:Individual
Prefix:MS
First Name:CHERYL
Middle Name:RENEE
Last Name:THIBAULT
Suffix:
Gender:F
Credentials:FNPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16466 PLUM RD
Mailing Address - Street 2:
Mailing Address - City:CALDWELL
Mailing Address - State:ID
Mailing Address - Zip Code:83607-9460
Mailing Address - Country:US
Mailing Address - Phone:208-455-0461
Mailing Address - Fax:
Practice Address - Street 1:920 MAIN ST
Practice Address - Street 2:
Practice Address - City:CALDWELL
Practice Address - State:ID
Practice Address - Zip Code:83605-3748
Practice Address - Country:US
Practice Address - Phone:208-455-5349
Practice Address - Fax:208-455-5350
Is Sole Proprietor?:No
Enumeration Date:2006-12-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDNP295A363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily