Healthcare Provider Details

I. General information

NPI: 1013589415
Provider Name (Legal Business Name): SHEILA ANN THIBODEAUX RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/14/2021
Last Update Date: 07/14/2021
Certification Date: 07/14/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

277 BILTMORE AVE
ASHEVILLE NC
28801-4157
US

IV. Provider business mailing address

277 BILTMORE AVE
ASHEVILLE NC
28801-4157
US

V. Phone/Fax

Practice location:
  • Phone: 877-277-8873
  • Fax: 828-505-0366
Mailing address:
  • Phone: 877-277-8873
  • Fax: 828-505-0366

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number212369
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: