Healthcare Provider Details

I. General information

NPI: 1821404278
Provider Name (Legal Business Name): NELLIE F NADEAU MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/07/2014
Last Update Date: 02/05/2021
Certification Date: 02/05/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4951 BUSINESS PARK BLVD
ANCHORAGE AK
99503
US

IV. Provider business mailing address

4951 BUSINESS PARK BLVD
ANCHORAGE AK
99503-7174
US

V. Phone/Fax

Practice location:
  • Phone: 907-743-7200
  • Fax: 907-743-7241
Mailing address:
  • Phone: 907-743-7200
  • Fax: 907-743-7241

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number8328
License Number StateAK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: