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General NPI Number Information
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NPI Number | 1063964385
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Entity Type | Individual
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Provider Name | JONNYE-LEA THIBODEAU CNP
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Gender | Female
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Dates
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Enumeration Date | 11/03/2016
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Last Update Date | 11/03/2016
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Provider Practice Location Address
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Address Line | 50 E MAIN ST
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City | HARRINGTON
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State | ME
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Zip | 04643-3043
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Country | US
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Telephone | 207-483-4502
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Fax | 207-483-2525
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Provider Business Mailing Address
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Address Line | 50 E MAIN ST
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City | HARRINGTON
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State | ME
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Zip | 04643-3043
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Country | US
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Telephone | 207-483-4502
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Fax | 207-483-2525
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number | CNP161183
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License Number State | ME
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