Provider Demographics
NPI:1982613725
Name:THIBODEAU, FAITH ALICE (RD)
Entity type:Individual
Prefix:
First Name:FAITH
Middle Name:ALICE
Last Name:THIBODEAU
Suffix:
Gender:F
Credentials:RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7 SIMPSON RD
Mailing Address - Street 2:
Mailing Address - City:SACO
Mailing Address - State:ME
Mailing Address - Zip Code:04072-9554
Mailing Address - Country:US
Mailing Address - Phone:207-284-4537
Mailing Address - Fax:207-284-4537
Practice Address - Street 1:7 SIMPSON RD
Practice Address - Street 2:
Practice Address - City:SACO
Practice Address - State:ME
Practice Address - Zip Code:04072-9554
Practice Address - Country:US
Practice Address - Phone:207-284-4537
Practice Address - Fax:207-284-4537
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-07
Last Update Date:2010-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MED171133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME001056OtherANTHEM
ME7773372OtherAETNA
ME8760206OtherCIGNA
MEP00300632OtherPALMETTO GBA
ME001056OtherANTHEM