Provider Demographics
NPI:1295507671
Name:NADEAU, LISA NICOLE
Entity type:Individual
Prefix:
First Name:LISA
Middle Name:NICOLE
Last Name:NADEAU
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5985 TURTLE LAKE RD
Mailing Address - Street 2:
Mailing Address - City:SHOREVIEW
Mailing Address - State:MN
Mailing Address - Zip Code:55126-4679
Mailing Address - Country:US
Mailing Address - Phone:651-352-3313
Mailing Address - Fax:
Practice Address - Street 1:5985 TURTLE LAKE RD
Practice Address - Street 2:
Practice Address - City:SHOREVIEW
Practice Address - State:MN
Practice Address - Zip Code:55126-4679
Practice Address - Country:US
Practice Address - Phone:651-352-3131
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-10-27
Last Update Date:2023-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer