Provider Demographics
NPI:1497846612
Name:NADEAU, JOSEPH H (PAC)
Entity Type:Individual
Prefix:MR
First Name:JOSEPH
Middle Name:H
Last Name:NADEAU
Suffix:
Gender:M
Credentials:PAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:400 E 5TH AVE
Mailing Address - Street 2:
Mailing Address - City:SPOKANE
Mailing Address - State:WA
Mailing Address - Zip Code:99202-1334
Mailing Address - Country:US
Mailing Address - Phone:509-838-2531
Mailing Address - Fax:509-342-3968
Practice Address - Street 1:20 E. J. STREET
Practice Address - Street 2:
Practice Address - City:DEER PARK
Practice Address - State:WA
Practice Address - Zip Code:99006
Practice Address - Country:US
Practice Address - Phone:509-755-5424
Practice Address - Fax:509-755-5425
Is Sole Proprietor?:No
Enumeration Date:2006-09-27
Last Update Date:2012-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPA10004094363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
S58165Medicare UPIN