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General NPI Number Information
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NPI Number | 1932099876
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Entity Type | Individual
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Provider Name | ROBERT J THIBERT CHW
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Gender | Male
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Dates
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Enumeration Date | 07/03/2025
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Last Update Date | 07/03/2025
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Provider Practice Location Address
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Address Line | 15855 MAIN AVE
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City | RED LAKE
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State | MN
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Zip | 56671
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Country | US
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Telephone | 218-679-3228
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Fax |
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Provider Business Mailing Address
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Address Line | 403 5TH ST NW STE 120
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City | BEMIDJI
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State | MN
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Zip | 56601
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Country | US
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Telephone | 218-444-8876
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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 | 172V00000X
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Taxonomy Name | Community Health Worker
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License Number |
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License Number State |
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