Individual
MR. PATRICK ROLAND THIBEAULT
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
14018 S ANNAPOLIS CT, CEDAR LAKE, IN 46303-7283
(219) 765-9141
Mailing address
14018 S ANNAPOLIS CT, CEDAR LAKE, IN 46303-7283
(219) 765-9141
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
28143935A
IN
363LF0000X
Family Nurse Practitioner
Primary
71002960A
IN
Other
Enumeration date
04/14/2009
Last updated
05/03/2013
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