Provider Demographics
NPI:1962239533
Name:THIBODEAUX, DENISE
Entity type:Individual
Prefix:
First Name:DENISE
Middle Name:
Last Name:THIBODEAUX
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 1:24505 LYNDON
Mailing Address - Street 2:
Mailing Address - City:REDFORD
Mailing Address - State:MI
Mailing Address - Zip Code:48239-3304
Mailing Address - Country:US
Mailing Address - Phone:248-318-5239
Mailing Address - Fax:
Practice Address - Street 1:336 W 1ST ST STE 113
Practice Address - Street 2:
Practice Address - City:FLINT
Practice Address - State:MI
Practice Address - Zip Code:48502-1382
Practice Address - Country:US
Practice Address - Phone:248-318-5239
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-09-18
Last Update Date:2024-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374J00000XNursing Service Related ProvidersDoula