Provider Demographics
NPI:1922048297
Name:REANDEAU, CONNIE PAULINE (ARNP)
Entity Type:Individual
Prefix:MS
First Name:CONNIE
Middle Name:PAULINE
Last Name:REANDEAU
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9442 FAGAN CT NE
Mailing Address - Street 2:
Mailing Address - City:LACEY
Mailing Address - State:WA
Mailing Address - Zip Code:98516-6600
Mailing Address - Country:US
Mailing Address - Phone:360-561-8043
Mailing Address - Fax:
Practice Address - Street 1:9442 FAGAN CT NE
Practice Address - Street 2:
Practice Address - City:LACEY
Practice Address - State:WA
Practice Address - Zip Code:98516-6600
Practice Address - Country:US
Practice Address - Phone:360-561-8043
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WARN00074574163W00000X
WAAP30003542363LW0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered163W00000XNursing Service ProvidersRegistered Nurse
Not Answered363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA9613878Medicaid