Provider Demographics
NPI:1942235411
Name:THIBAULT, ANNE M (NP)
Entity Type:Individual
Prefix:
First Name:ANNE
Middle Name:M
Last Name:THIBAULT
Suffix:
Gender:F
Credentials:NP
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Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:DEPT 34929
Mailing Address - Street 2:P.O. BOX 39000
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94139-0001
Mailing Address - Country:US
Mailing Address - Phone:925-952-2828
Mailing Address - Fax:925-952-2850
Practice Address - Street 1:106 LA CASA VIA
Practice Address - Street 2:SUITE 100
Practice Address - City:WALNUT CREEK
Practice Address - State:CA
Practice Address - Zip Code:94598-3086
Practice Address - Country:US
Practice Address - Phone:925-280-8777
Practice Address - Fax:925-937-1971
Is Sole Proprietor?:No
Enumeration Date:2006-07-12
Last Update Date:2012-06-21
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
CANP5374363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAP05464Medicare UPIN
CAONP53740Medicare PIN