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General NPI Number Information
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NPI Number | 1801087424
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Entity Type | Individual
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Provider Name | SAGE ELIZABETH THIBDEAU PA
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Gender | Female
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Dates
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Enumeration Date | 08/08/2007
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Last Update Date | 10/15/2024
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Provider Practice Location Address
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Address Line | 698 BRIGGS ST
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City | ERIE
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State | CO
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Zip | 80516
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Country | US
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Telephone | 720-618-7098
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Fax |
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Provider Business Mailing Address
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Address Line | 561 W 173RD PL
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City | BROOMFIELD
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State | CO
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Zip | 80023-5202
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Country | US
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Telephone | 720-618-7098
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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 | 103TC2200X
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Taxonomy Name | Clinical Child & Adolescent Psychologist
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License Number | 3267
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License Number State | CO
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Taxonomy #2
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Taxonomy Code | 363AM0700X
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Taxonomy Name | Medical Physician Assistant
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License Number | 3267
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License Number State | CO
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Taxonomy #3
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Taxonomy Code | 363AM0700X
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Taxonomy Name | Medical Physician Assistant
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License Number | 011930
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License Number State | NY
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Taxonomy #4
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | 3267
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License Number State | CO
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