Provider Demographics
NPI:1700491214
Name:THEBERT, JANICE
Entity Type:Individual
Prefix:
First Name:JANICE
Middle Name:
Last Name:THEBERT
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:PO BOX 85
Mailing Address - Street 2:
Mailing Address - City:ROSEWOOD
Mailing Address - State:OH
Mailing Address - Zip Code:43070-0085
Mailing Address - Country:US
Mailing Address - Phone:937-214-0584
Mailing Address - Fax:
Practice Address - Street 1:10881 W STATE ROUTE 29
Practice Address - Street 2:
Practice Address - City:ROSEWOOD
Practice Address - State:OH
Practice Address - Zip Code:43070-0085
Practice Address - Country:US
Practice Address - Phone:937-214-0584
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-09-11
Last Update Date:2020-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant
No253Z00000XAgenciesIn Home Supportive Care
No347C00000XTransportation ServicesPrivate Vehicle