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Individual

JOSEPH C THERIAULT

Active
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Individual

JOSEPH C THERIAULT

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
CNM

Taxonomy

Speciality
Code
Description
License number
State
176B00000X
Midwife
04290
OH
367A00000X
Advanced Practice Midwife
Primary
NM-04290
OH

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000031422
ANTHEM
OH
01
—
05225
PARAMOUNT
OH
05
—
2065045
—
OH
01
—
344428256
BEECHSTREET
OH
01
—
344428256090
CARESOURCE
OH
05
—
3471545
—
MI
Enumeration date
07/14/2005
Last updated
02/19/2014
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