Provider Demographics
NPI:1841798790
Name:THIBOS, NANCY L (RN)
Entity Type:Individual
Prefix:MRS
First Name:NANCY
Middle Name:L
Last Name:THIBOS
Suffix:
Gender:F
Credentials:RN
Other - Prefix:MS
Other - First Name:NANCY
Other - Middle Name:L
Other - Last Name:THIBOS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LPN
Mailing Address - Street 1:3285 122ND AVE
Mailing Address - Street 2:
Mailing Address - City:ALLEGAN
Mailing Address - State:MI
Mailing Address - Zip Code:49010-9511
Mailing Address - Country:US
Mailing Address - Phone:269-673-2738
Mailing Address - Fax:269-686-5260
Practice Address - Street 1:3285 122ND AVE
Practice Address - Street 2:
Practice Address - City:ALLEGAN
Practice Address - State:MI
Practice Address - Zip Code:49010-9511
Practice Address - Country:US
Practice Address - Phone:269-673-2738
Practice Address - Fax:269-686-5260
Is Sole Proprietor?:No
Enumeration Date:2018-01-25
Last Update Date:2018-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704286510163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse