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General NPI Number Information
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NPI Number | 1497208623
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Entity Type | Individual
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Provider Name | LAURA CATHERINE THIBODEAU PA-C
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Gender | Female
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Dates
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Enumeration Date | 07/23/2016
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Last Update Date | 02/12/2026
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Provider Practice Location Address
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Address Line | 4311 E LOHMAN AVE
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City | LAS CRUCES
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State | NM
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Zip | 88011-8255
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Country | US
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Telephone | 575-556-6800
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Fax |
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Provider Business Mailing Address
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Address Line | 77 BAKER LN
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City | ERIE
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State | CO
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Zip | 80516-9059
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Country | US
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Telephone | 575-636-4297
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Fax |
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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 | 363AM0700X
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Taxonomy Name | Medical Physician Assistant
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | PA12107
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License Number State | TX
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