Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207V00000X | Obstetrician & Gynecologist | ME147842 | FL |
N | 207VX0000X | Obstetrician | MD.305061 | LA |
NPI | 1245572031 |
---|---|
Provider Name | Vanessa Cloutier Thibodeaux |
First Address | Fort Walton Beach, FL 32547-1796 |
Second Address | Fort Walton Beach, FL 32547-1796 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 20/03/2013 |
Last Update Date | 01/02/2022 |