Individual
GINGER NICHOLE THIBAULT
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
9040 JACKSON AVE, TACOMA, WA 98431-4426
(253) 968-2464
(253) 968-0384
Mailing address
1985 GARRY OAKS AVE UNIT B, DUPONT, WA 98327-6703
(405) 905-0212
Taxonomy
Speciality
Code
Description
License number
State
163WP0200X
Pediatric Registered Nurse
R0077265
OK
363LP0200X
Pediatric Nurse Practitioner
AP61333001
WA
363LP0200X
Pediatric Nurse Practitioner
Primary
R0077265
OK
Other
Enumeration date
02/06/2015
Last updated
08/12/2022
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