Provider Demographics
NPI:1437521838
Name:NADEAU, TILANI (PA)
Entity Type:Individual
Prefix:
First Name:TILANI
Middle Name:
Last Name:NADEAU
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:TILANI
Other - Middle Name:
Other - Last Name:LOWMAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA
Mailing Address - Street 1:PO BOX 87388
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28304-7388
Mailing Address - Country:US
Mailing Address - Phone:703-943-6966
Mailing Address - Fax:
Practice Address - Street 1:1880 QUIET CV
Practice Address - Street 2:
Practice Address - City:FAYETTEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28304-3857
Practice Address - Country:US
Practice Address - Phone:910-323-2477
Practice Address - Fax:910-323-1913
Is Sole Proprietor?:No
Enumeration Date:2015-10-24
Last Update Date:2016-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDC0005950363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC1437521838OtherSTATE LICENSE