Provider Demographics
NPI:1558383695
Name:TANENBAUM, NADINE D (MD)
Entity Type:Individual
Prefix:DR
First Name:NADINE
Middle Name:D
Last Name:TANENBAUM
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 209
Mailing Address - Street 2:
Mailing Address - City:CHICO
Mailing Address - State:CA
Mailing Address - Zip Code:95927-0209
Mailing Address - Country:US
Mailing Address - Phone:530-899-7090
Mailing Address - Fax:530-899-2765
Practice Address - Street 1:3011 CERES AVE
Practice Address - Street 2:SUITE 100
Practice Address - City:CHICO
Practice Address - State:CA
Practice Address - Zip Code:95973-7898
Practice Address - Country:US
Practice Address - Phone:530-899-7090
Practice Address - Fax:530-899-2765
Is Sole Proprietor?:No
Enumeration Date:2006-07-25
Last Update Date:2010-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA110240207RN0300X
MO2006009470207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAPENDINGMedicaid
MO201082203Medicaid
IL$$$$$$$$$Medicaid
MO201082203Medicaid
960110183Medicare PIN
CAPENDINGMedicare PIN
P00342080Medicare PIN