Provider Demographics
NPI:1457661035
Name:THIBAUD, MARIE
Entity Type:Individual
Prefix:
First Name:MARIE
Middle Name:
Last Name:THIBAUD
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9419 AVENUE N
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11236-5334
Mailing Address - Country:US
Mailing Address - Phone:347-512-8596
Mailing Address - Fax:347-240-1597
Practice Address - Street 1:9410 AVENUE N
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11236-5334
Practice Address - Country:US
Practice Address - Phone:347-512-8596
Practice Address - Fax:347-240-1597
Is Sole Proprietor?:Yes
Enumeration Date:2010-10-15
Last Update Date:2010-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY3027671164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse