Provider Demographics
NPI:1033561303
Name:WEBB, NADENE ANDREA
Entity Type:Individual
Prefix:
First Name:NADENE
Middle Name:ANDREA
Last Name:WEBB
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:NADENE
Other - Middle Name:ANDREA
Other - Last Name:HENDERSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:106 LOCUSTWOOD BLVD
Mailing Address - Street 2:
Mailing Address - City:ELMONT
Mailing Address - State:NY
Mailing Address - Zip Code:11003-1411
Mailing Address - Country:US
Mailing Address - Phone:631-355-9542
Mailing Address - Fax:
Practice Address - Street 1:106 LOCUSTWOOD BLVD
Practice Address - Street 2:
Practice Address - City:ELMONT
Practice Address - State:NY
Practice Address - Zip Code:11003-1411
Practice Address - Country:US
Practice Address - Phone:631-355-9542
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-07-11
Last Update Date:2016-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1278273174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist