MEDICARE: MRS. MARY E THIBERT N.P.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LA2100X	Acute Care Nurse Practitioner	4704186700	MI

General Provider Information

NPI Number	:	1457507287
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. MARY E THIBERT N.P.

Provider Business Mailing Address
First Line	:	1886 W AUBURN RD
Second Line	:	SUITE 400
City	:	ROCHESTER HILLS
State	:	MI
Zip	:	48309-3865
Country	:	US
Telephone Number	:	248-290-3111
Fax Number	:	248-290-3100

Provider Business Practice Location Address
First Line	:	1886 W AUBURN RD
Second Line	:	SUITE 400
City	:	ROCHESTER HILLS
State	:	MI
Zip	:	48309-3865
Country	:	US
Telephone Number	:	248-290-3111
Fax Number	:	248-290-3100

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/12/2008
Last Update Date	:	12/09/2009

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