Provider Demographics
NPI:1265592711
Name:GADUE, DALE R (RN)
Entity type:Individual
Prefix:
First Name:DALE
Middle Name:R
Last Name:GADUE
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 1:1552 TWISTED OAK DR
Mailing Address - Street 2:
Mailing Address - City:RESTON
Mailing Address - State:VA
Mailing Address - Zip Code:20194-1539
Mailing Address - Country:US
Mailing Address - Phone:703-787-0630
Mailing Address - Fax:
Practice Address - Street 1:3900 JERMANTOWN RD
Practice Address - Street 2:
Practice Address - City:FAIRFAX
Practice Address - State:VA
Practice Address - Zip Code:22030-4900
Practice Address - Country:US
Practice Address - Phone:703-934-8715
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0001130768163WA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WA0400XNursing Service ProvidersRegistered NurseAddiction (Substance Use Disorder)