Provider Demographics
NPI:1588442990
Name:KIBLER, THAIS
Entity type:Individual
Prefix:
First Name:THAIS
Middle Name:
Last Name:KIBLER
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 1:1705 WIESBROCK LN
Mailing Address - Street 2:
Mailing Address - City:BATAVIA
Mailing Address - State:IL
Mailing Address - Zip Code:60510-9004
Mailing Address - Country:US
Mailing Address - Phone:312-590-0415
Mailing Address - Fax:
Practice Address - Street 1:1705 WIESBROCK LN
Practice Address - Street 2:
Practice Address - City:BATAVIA
Practice Address - State:IL
Practice Address - Zip Code:60510-9004
Practice Address - Country:US
Practice Address - Phone:312-590-0415
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-09-18
Last Update Date:2023-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL041438493163WP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WP0808XNursing Service ProvidersRegistered NursePsychiatric/Mental Health