Provider Demographics
NPI:1114548443
Name:VIDEAU, NINA MARIELLE (MD)
Entity Type:Individual
Prefix:DR
First Name:NINA
Middle Name:MARIELLE
Last Name:VIDEAU
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 MEDICAL CENTER BLVD SURGERY CLINIC
Mailing Address - Street 2:
Mailing Address - City:WINSTON SALEM
Mailing Address - State:NC
Mailing Address - Zip Code:27157-3686
Mailing Address - Country:US
Mailing Address - Phone:336-716-0423
Mailing Address - Fax:336-716-5537
Practice Address - Street 1:1 MEDICAL CENTER BLVD SURGERY CLINIC
Practice Address - Street 2:
Practice Address - City:WINSTON SALEM
Practice Address - State:NC
Practice Address - Zip Code:27157-0001
Practice Address - Country:US
Practice Address - Phone:336-716-0423
Practice Address - Fax:336-716-5537
Is Sole Proprietor?:No
Enumeration Date:2020-04-27
Last Update Date:2020-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program