Patrick Roland Thibeault

Primary specialty

Family Nurse PractitionerTaxonomy code 363LF0000X

License

71002960A Issued in IN

Practice address

14018 S Annapolis CT
Cedar Lake, IN 46303-7283

Phone

(219) 765-9141

NPI assigned

Apr 14, 2009

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1239667200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1367539200000",
    "number": "1437392834",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "14018 S ANNAPOLIS CT",
            "city": "CEDAR LAKE",
            "state": "IN",
            "postal_code": "463037283",
            "telephone_number": "219-765-9141"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "14018 S ANNAPOLIS CT",
            "city": "CEDAR LAKE",
            "state": "IN",
            "postal_code": "463037283",
            "telephone_number": "219-765-9141"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "THIBEAULT",
        "first_name": "PATRICK",
        "middle_name": "ROLAND",
        "name_prefix": "Mr.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2009-04-14",
        "last_updated": "2013-05-03",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "163W00000X",
            "taxonomy_group": "",
            "desc": "Registered Nurse",
            "state": "IN",
            "license": "28143935A",
            "primary": false
        },
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "IN",
            "license": "71002960A",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Amanda Stolarz, MSN, FNP-C
• Regina Gale Stovall, OTR
• Erica Tambrini
• Kimberly Ann Tancos, MS
• Therapeutic Branches, P.C.
• Christina M Topoll
• Town of Cedar Lake
• United Emergency Medical Services
• Jessica Van Noort
• Lynn J Vattathara, MD

• Family Nurse Practitioner in Cedar Lake, IN
• Providers in Cedar Lake, IN by specialty
• Family Nurse Practitioner in Indiana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 3, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.