Healthcare Provider Details

I. General information

NPI: 1770065781
Provider Name (Legal Business Name): GEORGETTE L NADEAU APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/06/2018
Last Update Date: 02/22/2024
Certification Date: 02/22/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

296 S PACIFIC HWY
TALENT OR
97540-6649
US

IV. Provider business mailing address

296 S PACIFIC HWY
TALENT OR
97540-6649
US

V. Phone/Fax

Practice location:
  • Phone: 541-646-1066
  • Fax: 541-615-9308
Mailing address:
  • Phone: 541-646-9928
  • Fax: 541-615-9308

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAP141118
License Number StateTX
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number10007782
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: