Renee Thibault, L.AC

Primary specialty

AcupuncturistTaxonomy code 171100000X

License

AC419 Issued in ME

Practice address

157 Park St Ste 22
Bangor, ME 04401-5094

Phone

(207) 941-8010

NPI assigned

May 17, 2009

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

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

{
    "created_epoch": "1242518400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1391990400000",
    "number": "1952536260",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "151 CHAPMAN RD",
            "city": "NEWBURGH",
            "state": "ME",
            "postal_code": "044445149",
            "telephone_number": "207-922-8128"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "157 PARK ST STE 22",
            "city": "BANGOR",
            "state": "ME",
            "postal_code": "044015094",
            "telephone_number": "207-941-8010"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "THIBAULT",
        "first_name": "RENEE",
        "name_prefix": "Ms.",
        "credential": "L.AC",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2009-05-17",
        "last_updated": "2014-02-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "171100000X",
            "taxonomy_group": "",
            "desc": "Acupuncturist",
            "state": "ME",
            "license": "AC419",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• The Maine Fitness Store, Inc
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• Amanda Ann Theriault, APRN-CNP
• Mary E Therriault, N.P.
• Jayne Elizabeth Gilbert Thibodeau, M.ED.
• Noel Edward Thibodeau
• Sheila Thibodeau, LCSW, CCS
• Kaylin Thies, DMD
• Thomas J Vanidestine Jr

• Acupuncturist in Bangor, ME
• Providers in Bangor, ME by specialty
• Acupuncturist in Maine

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 10, 2014; 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.