Basic Information
| Provider Information | |||||||||
| NPI: | 1710024161 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | THIBODEAU-ASHFORD | ||||||||
| FirstName: | ANN | ||||||||
| MiddleName: | C | ||||||||
| NamePrefix: | MRS. | ||||||||
| NameSuffix: | |||||||||
| Credential: | PHYSICIAN ASSISTANT | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | THIBODEAU | ||||||||
| OtherFirstName: | ANN | ||||||||
| OtherMiddleName: | C | ||||||||
| OtherNamePrefix: | |||||||||
| OtherNameSuffix: | |||||||||
| OtherCredential: | PHYSICIAN ASSISTANT | ||||||||
| OtherLastNameType: | 1 | ||||||||
| Mailing Information | |||||||||
| Address1: | 177 N BARLOW RD | ||||||||
| Address2: | |||||||||
| City: | HARRISVILLE | ||||||||
| State: | MI | ||||||||
| PostalCode: | 487409607 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9897368157 | ||||||||
| FaxNumber: | 9893583762 | ||||||||
| Practice Location | |||||||||
| Address1: | 177 N BARLOW RD | ||||||||
| Address2: | |||||||||
| City: | HARRISVILLE | ||||||||
| State: | MI | ||||||||
| PostalCode: | 487409607 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9897368157 | ||||||||
| FaxNumber: | 9893583762 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/01/2007 | ||||||||
| LastUpdateDate: | 01/25/2012 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| AuthorizedOfficialMiddleName: | |||||||||
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| AuthorizedOfficialTelephone: | |||||||||
| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363A00000X | 5601001126 | MI | Y | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant |
No ID Information.