Provider Demographics
NPI:1669809653
Name:THIBAULT, JEANETTE (APRN, CNP, FNP-C)
Entity type:Individual
Prefix:
First Name:JEANETTE
Middle Name:
Last Name:THIBAULT
Suffix:
Gender:F
Credentials:APRN, CNP, FNP-C
Other - Prefix:
Other - First Name:JEANETTE
Other - Middle Name:
Other - Last Name:GOURD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:400 BALD HILL ROAD
Mailing Address - Street 2:SUITE 511
Mailing Address - City:WARWICK
Mailing Address - State:RI
Mailing Address - Zip Code:02886
Mailing Address - Country:US
Mailing Address - Phone:401-738-8100
Mailing Address - Fax:
Practice Address - Street 1:400 BALD HILL ROAD
Practice Address - Street 2:SUITE 511
Practice Address - City:WARWICK
Practice Address - State:RI
Practice Address - Zip Code:02886
Practice Address - Country:US
Practice Address - Phone:401-738-8100
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-10-04
Last Update Date:2023-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIAPRN00134363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily