Provider Demographics
NPI:1073407060
Name:THIBADO, NANETTE MARIE (RN)
Entity type:Individual
Prefix:MISS
First Name:NANETTE
Middle Name:MARIE
Last Name:THIBADO
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1012 W COLVIN ST
Mailing Address - Street 2:
Mailing Address - City:SYRACUSE
Mailing Address - State:NY
Mailing Address - Zip Code:13207-1915
Mailing Address - Country:US
Mailing Address - Phone:315-935-6669
Mailing Address - Fax:
Practice Address - Street 1:620 MADISON ST.
Practice Address - Street 2:SUITE 120
Practice Address - City:SYRACUSE
Practice Address - State:NY
Practice Address - Zip Code:13210
Practice Address - Country:US
Practice Address - Phone:315-426-3600
Practice Address - Fax:315-426-3605
Is Sole Proprietor?:No
Enumeration Date:2025-06-05
Last Update Date:2025-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY812343163WP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WP0808XNursing Service ProvidersRegistered NursePsychiatric/Mental Health