Healthcare Provider Details

I. General information

NPI: 1821057274
Provider Name (Legal Business Name): JANET M THIBERT AU.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/22/2006
Last Update Date: 09/18/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2331 VELP AVE SUITE G
GREEN BAY WI
54303-6592
US

IV. Provider business mailing address

2331 VELP AVE SUITE G
GREEN BAY WI
54303-6592
US

V. Phone/Fax

Practice location:
  • Phone: 920-434-6777
  • Fax: 920-434-6988
Mailing address:
  • Phone: 920-434-6777
  • Fax: 920-434-6988

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code237600000X
TaxonomyAudiologist-Hearing Aid Fitter
License Number464-156
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: