Individual
ANITA THIBODEAUX
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
NP
Contact information
Practice address
900 S 6TH ST, LEESVILLE, LA 71446-4723
(337) 392-8118
Mailing address
900 S 6TH ST, LEESVILLE, LA 71446-4723
(337) 392-8118
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
RN31051-AP03789
LA
Other
Enumeration date
12/20/2021
Last updated
12/27/2021
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