Provider Demographics
NPI:1770665473
Name:TREADOW, JOAN (RN)
Entity Type:Individual
Prefix:
First Name:JOAN
Middle Name:
Last Name:TREADOW
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8 HICKORY LN
Mailing Address - Street 2:
Mailing Address - City:WATERFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06385-4210
Mailing Address - Country:US
Mailing Address - Phone:860-447-2588
Mailing Address - Fax:
Practice Address - Street 1:8 HICKORY LN
Practice Address - Street 2:
Practice Address - City:WATERFORD
Practice Address - State:CT
Practice Address - Zip Code:06385-4210
Practice Address - Country:US
Practice Address - Phone:860-447-2588
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CTE34537163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse