1447703129 NPI number — MS. TONETTE MARIE THIBODEAUX MAC/MHP

Table of content: MS. TONETTE MARIE THIBODEAUX MAC/MHP (NPI 1447703129)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1447703129 NPI number — MS. TONETTE MARIE THIBODEAUX MAC/MHP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
THIBODEAUX
Provider First Name:
TONETTE
Provider Middle Name:
MARIE
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
MAC/MHP
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
THIBODEAUX
Provider Other First Name:
TONETTE
Provider Other Middle Name:
BOXIE
Provider Other Name Prefix Text:
MS.
Provider Other Name Suffix Text:
Provider Other Credential Text:
MAC/MHP
Provider Other Last Name Type Code:
2

NPI Number Information

NPI Number:
1447703129
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
04/05/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
311 MACARTHUR DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SUNSET
Provider Business Mailing Address State Name:
LA
Provider Business Mailing Address Postal Code:
70584-6212
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
337-662-3737
Provider Business Mailing Address Fax Number:
337-662-3636

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
311 MACARTHUR DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SUNSET
Provider Business Practice Location Address State Name:
LA
Provider Business Practice Location Address Postal Code:
70584-6212
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
337-662-3737
Provider Business Practice Location Address Fax Number:
337-662-3636
Provider Enumeration Date:
07/28/2016

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 171M00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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