Provider Demographics
NPI:1073273306
Name:NEADEAU, MARCUS JAMES SR
Entity Type:Individual
Prefix:
First Name:MARCUS
Middle Name:JAMES
Last Name:NEADEAU
Suffix:SR
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4430 9TH AVENUE CIR S APT 102
Mailing Address - Street 2:
Mailing Address - City:FARGO
Mailing Address - State:ND
Mailing Address - Zip Code:58103-2005
Mailing Address - Country:US
Mailing Address - Phone:218-308-3998
Mailing Address - Fax:
Practice Address - Street 1:4430 9TH AVENUE CIR S APT 102
Practice Address - Street 2:
Practice Address - City:FARGO
Practice Address - State:ND
Practice Address - Zip Code:58103-2005
Practice Address - Country:US
Practice Address - Phone:218-308-3998
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-12-28
Last Update Date:2021-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant