Provider Demographics
NPI:1457507287
Name:THIBERT, MARY E (NP)
Entity Type:Individual
Prefix:MRS
First Name:MARY
Middle Name:E
Last Name:THIBERT
Suffix:
Gender:F
Credentials:NP
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Mailing Address - Street 1:1886 W AUBURN RD
Mailing Address - Street 2:SUITE 400
Mailing Address - City:ROCHESTER HILLS
Mailing Address - State:MI
Mailing Address - Zip Code:48309-3865
Mailing Address - Country:US
Mailing Address - Phone:248-290-3111
Mailing Address - Fax:248-290-3100
Practice Address - Street 1:1886 W AUBURN RD
Practice Address - Street 2:SUITE 400
Practice Address - City:ROCHESTER HILLS
Practice Address - State:MI
Practice Address - Zip Code:48309-3865
Practice Address - Country:US
Practice Address - Phone:248-290-3111
Practice Address - Fax:248-290-3100
Is Sole Proprietor?:No
Enumeration Date:2008-08-12
Last Update Date:2009-12-09
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MI4704186700363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
N82600011Medicare PIN