Individual
BRENT K THIBODEAUX
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
NP
Contact information
Practice address
1514 JEFFERSON HWY, NEW ORLEANS, LA 70121-2429
(504) 842-4000
Mailing address
1514 JEFFERSON HWY, NEW ORLEANS, LA 70121-2429
(504) 842-4000
Taxonomy
Speciality
Code
Description
License number
State
363LP2300X
Primary Care Nurse Practitioner
Primary
AP04823
LA
363LP2300X
Primary Care Nurse Practitioner
RN098583
LA
Other
Enumeration date
08/30/2006
Last updated
06/30/2011
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