Individual
GINA THIBODEAUX
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
AGNP
Contact information
Practice address
234 E 149TH ST, BRONX, NY 10451-5504
(718) 579-5820
(718) 579-5240
Mailing address
1746 N ORANGE DR APT 615, LOS ANGELES, CA 90028-4362
(504) 858-3505
Taxonomy
Speciality
Code
Description
License number
State
363LA2200X
Adult Health Nurse Practitioner
Primary
F307578-1
NY
Other
Enumeration date
02/11/2016
Last updated
02/11/2016
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