Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LN0000X | Nurse Practitioner - Neonatal | RN065691-AP02120 | LA |
N | 363LN0005X | Nurse Practitioner - Neonatal (Critical Care) | AP02120 | LA |
NPI | 1265754618 |
---|---|
Provider Name | Michele Rodrigue Thibodeaux |
First Address | Napoleonville, LA 70390-8728 |
Second Address | Baton Rouge, LA 70817-5128 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 25/02/2010 |
Last Update Date | 28/12/2016 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
2174703 | (05) | LA |