Provider Demographics
NPI:1508810334
Name:GAUDREAU, ROBERT LOUIS (ARNP)
Entity Type:Individual
Prefix:MR
First Name:ROBERT
Middle Name:LOUIS
Last Name:GAUDREAU
Suffix:
Gender:M
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:426 CALEF HIGHWAY
Mailing Address - Street 2:
Mailing Address - City:BARRINGTON
Mailing Address - State:NH
Mailing Address - Zip Code:03825
Mailing Address - Country:US
Mailing Address - Phone:603-664-0955
Mailing Address - Fax:603-664-7493
Practice Address - Street 1:426 CALEF HIGHWAY
Practice Address - Street 2:ROUTE 125
Practice Address - City:BARRINGTON
Practice Address - State:NH
Practice Address - Zip Code:03825
Practice Address - Country:US
Practice Address - Phone:603-664-0955
Practice Address - Fax:603-664-7493
Is Sole Proprietor?:No
Enumeration Date:2006-05-19
Last Update Date:2013-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH0372352303363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH30340826Medicaid
ME301000099Medicaid
500012710OtherRAILROAD MEDICARE
MA0388530Medicaid
NH4004043Y0NH01OtherANTHEM
MA0388530Medicaid
NH4004043Y0NH01OtherANTHEM
NP2034Medicare ID - Type Unspecified