Healthcare Provider Details

I. General information

NPI: 1497208623
Provider Name (Legal Business Name): LAURA CATHERINE THIBODEAU PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: LAURA CATHERINE FRANZONI PA-C

II. Dates (important events)

Enumeration Date: 07/23/2016
Last Update Date: 02/12/2026
Certification Date: 02/12/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4311 E LOHMAN AVE
LAS CRUCES NM
88011-8255
US

IV. Provider business mailing address

77 BAKER LN
ERIE CO
80516-9059
US

V. Phone/Fax

Practice location:
  • Phone: 575-556-6800
  • Fax:
Mailing address:
  • Phone: 575-636-4297
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA12107
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: