Provider Demographics
NPI:1396580254
Name:THIBEAU, CHASITY ANNE (CRMA/PSS)
Entity type:Individual
Prefix:
First Name:CHASITY
Middle Name:ANNE
Last Name:THIBEAU
Suffix:
Gender:F
Credentials:CRMA/PSS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17 BECKWITH LN
Mailing Address - Street 2:
Mailing Address - City:WEST GARDINER
Mailing Address - State:ME
Mailing Address - Zip Code:04345-3527
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:17 BECKWITH LN
Practice Address - Street 2:
Practice Address - City:WEST GARDINER
Practice Address - State:ME
Practice Address - Zip Code:04345-3527
Practice Address - Country:US
Practice Address - Phone:207-707-0481
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-07-01
Last Update Date:2024-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747A0650XNursing Service Related ProvidersTechnicianAttendant Care Provider