Provider Demographics
NPI:1427563147
Name:GAUDET, NEAL
Entity Type:Individual
Prefix:MR
First Name:NEAL
Middle Name:
Last Name:GAUDET
Suffix:
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 1:2260 PESNELL CT APT 4A
Mailing Address - Street 2:
Mailing Address - City:MOBILE
Mailing Address - State:AL
Mailing Address - Zip Code:36695-3805
Mailing Address - Country:US
Mailing Address - Phone:251-459-8671
Mailing Address - Fax:
Practice Address - Street 1:2260 PESNELL CT APT 4A
Practice Address - Street 2:
Practice Address - City:MOBILE
Practice Address - State:AL
Practice Address - Zip Code:36695-3805
Practice Address - Country:US
Practice Address - Phone:251-459-8671
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-12-04
Last Update Date:2017-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
374U00000X
AL1800447376J00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376J00000XNursing Service Related ProvidersHomemaker
No374U00000XNursing Service Related ProvidersHome Health Aide