Provider Demographics
NPI:1437184751
Name:THIBODEAU, CHARLENE A (RN)
Entity Type:Individual
Prefix:
First Name:CHARLENE
Middle Name:A
Last Name:THIBODEAU
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:58 HOPKINS HILL RD
Mailing Address - Street 2:
Mailing Address - City:COVENTRY
Mailing Address - State:RI
Mailing Address - Zip Code:02816-6317
Mailing Address - Country:US
Mailing Address - Phone:401-615-3289
Mailing Address - Fax:
Practice Address - Street 1:134 THURBERS AVE
Practice Address - Street 2:C/O FAMILY SERVICE OF RI
Practice Address - City:PROVIDENCE
Practice Address - State:RI
Practice Address - Zip Code:02905-4754
Practice Address - Country:US
Practice Address - Phone:401-331-1350
Practice Address - Fax:401-277-3366
Is Sole Proprietor?:No
Enumeration Date:2006-07-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIRN26277163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
RICT51867Medicaid