Individual
SUSAN M THIBEAULT
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CRNA, APRN
Contact information
Practice address
326 WASHINGTON STREET, NORWICH, CT 18764
(860) 889-8331
(703) 766-9725
Mailing address
3998 FAIR RIDGE DRIVE, SUITE 300, FAIRFAX, VA 22033
(703) 295-9360
(703) 766-9725
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
Primary
003212
CT
367500000X
Certified Registered Nurse Anesthetist
3212
CT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
004250403
—
CT
Enumeration date
08/01/2006
Last updated
03/25/2015
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