Provider Demographics
NPI:1427584093
Name:NEDEAU, NATALIE ROSE (APRN, FNP-C)
Entity Type:Individual
Prefix:
First Name:NATALIE
Middle Name:ROSE
Last Name:NEDEAU
Suffix:
Gender:F
Credentials:APRN, FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:27450 YNEZ RD STE 100
Mailing Address - Street 2:
Mailing Address - City:TEMECULA
Mailing Address - State:CA
Mailing Address - Zip Code:92591-4649
Mailing Address - Country:US
Mailing Address - Phone:951-383-4333
Mailing Address - Fax:951-383-4333
Practice Address - Street 1:27450 YNEZ RD STE 100
Practice Address - Street 2:
Practice Address - City:TEMECULA
Practice Address - State:CA
Practice Address - Zip Code:92591-4649
Practice Address - Country:US
Practice Address - Phone:951-383-4333
Practice Address - Fax:951-506-2361
Is Sole Proprietor?:No
Enumeration Date:2017-05-02
Last Update Date:2022-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95014290363L00000X, 363L00000X
NVAPRN002566363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
14003283OtherCAQH