Provider Demographics
NPI:1922410059
Name:BEAUDREAU, CATHERINE MELISSA (NP)
Entity Type:Individual
Prefix:
First Name:CATHERINE
Middle Name:MELISSA
Last Name:BEAUDREAU
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:CATHY
Other - Middle Name:
Other - Last Name:BEAUDREAU
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:NP
Mailing Address - Street 1:6500 RED HOOK PLZ
Mailing Address - Street 2:SUITE 205
Mailing Address - City:ST THOMAS
Mailing Address - State:VI
Mailing Address - Zip Code:00802-1306
Mailing Address - Country:US
Mailing Address - Phone:340-775-2303
Mailing Address - Fax:340-779-2077
Practice Address - Street 1:6500 RED HOOK PLZ
Practice Address - Street 2:SUITE 205
Practice Address - City:ST THOMAS
Practice Address - State:VI
Practice Address - Zip Code:00802-1306
Practice Address - Country:US
Practice Address - Phone:340-775-2303
Practice Address - Fax:340-779-2077
Is Sole Proprietor?:No
Enumeration Date:2014-05-23
Last Update Date:2014-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VIAP12528363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily