Provider Demographics
NPI:1144391962
Name:NADELEN, THEODORE R III (MS, RN, FNP)
Entity Type:Individual
Prefix:MR
First Name:THEODORE
Middle Name:R
Last Name:NADELEN
Suffix:III
Gender:M
Credentials:MS, RN, FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:300 WEST AVE
Mailing Address - Street 2:
Mailing Address - City:BROCKPORT
Mailing Address - State:NY
Mailing Address - Zip Code:14420-1118
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:77 S MAIN ST
Practice Address - Street 2:
Practice Address - City:LYNDONVILLE
Practice Address - State:NY
Practice Address - Zip Code:14098-9771
Practice Address - Country:US
Practice Address - Phone:585-765-2060
Practice Address - Fax:585-765-2067
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-13
Last Update Date:2013-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY334787-1363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily