Healthcare Provider Details

I. General information

NPI: 1194594119
Provider Name (Legal Business Name): SUSAN MARIE NADEAU RPH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/02/2024
Last Update Date: 01/02/2024
Certification Date: 01/02/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

401 BICENTENNIAL WAY STE 160
SANTA ROSA CA
95403-2149
US

IV. Provider business mailing address

1742 SPRUCE ST
NAPA CA
94559-4506
US

V. Phone/Fax

Practice location:
  • Phone: 707-393-4634
  • Fax:
Mailing address:
  • Phone: 707-738-2044
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1835X0200X
TaxonomyOncology Pharmacist
License Number40818
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: