Individual
SAMUEL J THIBODEAUX
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
CRNA
Contact information
Practice address
271 OBSERVATORY AVE, UKIAH, CA 95482-5757
(707) 462-0681
Mailing address
PO BOX 34120, RENO, NV 89533-4120
(775) 747-5050
(775) 747-5005
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
D105288
IA
367500000X
Certified Registered Nurse Anesthetist
Primary
NA3796
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0469627
—
IA
01
—
39651
WELLMARK BCBS
IA
Enumeration date
11/08/2005
Last updated
03/22/2013
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