Provider Demographics
NPI:1770065781
Name:NADEAU, GEORGETTE L (APRN)
Entity type:Individual
Prefix:
First Name:GEORGETTE
Middle Name:L
Last Name:NADEAU
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:296 S PACIFIC HWY
Mailing Address - Street 2:
Mailing Address - City:TALENT
Mailing Address - State:OR
Mailing Address - Zip Code:97540-6649
Mailing Address - Country:US
Mailing Address - Phone:541-646-9928
Mailing Address - Fax:541-615-9308
Practice Address - Street 1:296 S PACIFIC HWY
Practice Address - Street 2:
Practice Address - City:TALENT
Practice Address - State:OR
Practice Address - Zip Code:97540-6649
Practice Address - Country:US
Practice Address - Phone:541-646-1066
Practice Address - Fax:541-615-9308
Is Sole Proprietor?:Yes
Enumeration Date:2018-09-06
Last Update Date:2024-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP141118363LF0000X
OR10007782363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily