Provider Demographics
NPI:1740450030
Name:THEBEAU, SUZANNE MARIE (WHNP-BC)
Entity type:Individual
Prefix:
First Name:SUZANNE
Middle Name:MARIE
Last Name:THEBEAU
Suffix:
Gender:F
Credentials:WHNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7121 S PADRE ISLAND DR
Mailing Address - Street 2:SUITE 200
Mailing Address - City:CORPUS CHRISTI
Mailing Address - State:TX
Mailing Address - Zip Code:78412-4938
Mailing Address - Country:US
Mailing Address - Phone:361-993-6000
Mailing Address - Fax:361-561-1295
Practice Address - Street 1:7121 S PADRE ISLAND DR
Practice Address - Street 2:SUITE 200
Practice Address - City:CORPUS CHRISTI
Practice Address - State:TX
Practice Address - Zip Code:78412-4938
Practice Address - Country:US
Practice Address - Phone:361-993-6000
Practice Address - Fax:361-561-1295
Is Sole Proprietor?:No
Enumeration Date:2008-03-03
Last Update Date:2008-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX248045363LW0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health