Provider Demographics
NPI:1598016230
Name:NADEAU, JAYDEN (NP)
Entity Type:Individual
Prefix:
First Name:JAYDEN
Middle Name:
Last Name:NADEAU
Suffix:
Gender:M
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3030 N CENTRAL AVE
Mailing Address - Street 2:SUITE 1407
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85012-2707
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:3030 N CENTRAL AVE
Practice Address - Street 2:SUITE 1407
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85012-2707
Practice Address - Country:US
Practice Address - Phone:602-253-5100
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-09-20
Last Update Date:2012-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZAP4645363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health