Provider Demographics
NPI:1346232592
Name:NEDEAU, CHRISTINE I (MD, FAAFP)
Entity Type:Individual
Prefix:DR
First Name:CHRISTINE
Middle Name:I
Last Name:NEDEAU
Suffix:
Gender:F
Credentials:MD, FAAFP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9787 N CEDAR AVE
Mailing Address - Street 2:
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64157-6208
Mailing Address - Country:US
Mailing Address - Phone:816-408-3717
Mailing Address - Fax:816-429-9762
Practice Address - Street 1:9787 N CEDAR AVE
Practice Address - Street 2:
Practice Address - City:KANSAS CITY
Practice Address - State:MO
Practice Address - Zip Code:64157-6208
Practice Address - Country:US
Practice Address - Phone:816-408-3717
Practice Address - Fax:816-429-9762
Is Sole Proprietor?:No
Enumeration Date:2005-08-15
Last Update Date:2023-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO0000747207Q00000X
MO2002022546207Q00000X
AZ61535207Q00000X
KS0441013207Q00000X
MOMD2002022546207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO205913700Medicaid
MO205913700Medicaid
MO342B977Medicare ID - Type Unspecified