Provider Demographics
NPI:1407581499
Name:NADEAU, DIANE MARIE (RN CDOE)
Entity Type:Individual
Prefix:
First Name:DIANE
Middle Name:MARIE
Last Name:NADEAU
Suffix:
Gender:F
Credentials:RN CDOE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2 MAXSON HILL RD
Mailing Address - Street 2:
Mailing Address - City:ASHAWAY
Mailing Address - State:RI
Mailing Address - Zip Code:02804
Mailing Address - Country:US
Mailing Address - Phone:401-287-1153
Mailing Address - Fax:
Practice Address - Street 1:2 MAXSON HILL RD
Practice Address - Street 2:
Practice Address - City:ASHAWAY
Practice Address - State:RI
Practice Address - Zip Code:02804
Practice Address - Country:US
Practice Address - Phone:401-287-1153
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-07-22
Last Update Date:2022-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RI20280163W00000X
CT177864163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
RI20280OtherRN LICENSE
CT177864OtherRN LICENSE