Provider Demographics
NPI:1023100575
Name:NADEAU, RANDINE D (PMHNP, FNP)
Entity type:Individual
Prefix:
First Name:RANDINE
Middle Name:D
Last Name:NADEAU
Suffix:
Gender:F
Credentials:PMHNP, FNP
Other - Prefix:
Other - First Name:RANDINE
Other - Middle Name:D
Other - Last Name:PUTZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3835 N FREEWAY BLVD STE 100
Mailing Address - Street 2:
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95834-1954
Mailing Address - Country:US
Mailing Address - Phone:855-501-1004
Mailing Address - Fax:866-279-1549
Practice Address - Street 1:4 DOCTORS PARK STE H
Practice Address - Street 2:
Practice Address - City:ASHEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28801-4523
Practice Address - Country:US
Practice Address - Phone:855-501-1004
Practice Address - Fax:866-279-1549
Is Sole Proprietor?:No
Enumeration Date:2006-09-29
Last Update Date:2024-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC5001115363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC6113110Medicaid
NCS64732Medicare UPIN