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General NPI Number Information
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NPI Number | 1851825301
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Entity Type | Individual
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Provider Name | LISA NADEAU
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Gender | Female
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Dates
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Enumeration Date | 04/11/2017
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Last Update Date | 02/14/2023
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Provider Practice Location Address
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Address Line | 232 S WOODS MILL RD
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City | CHESTERFIELD
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State | MO
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Zip | 63017-3406
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Country | US
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Telephone | 314-265-5695
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Fax |
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Provider Business Mailing Address
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Address Line | 915 SAINT RITA AVE APT 1S
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City | SAINT LOUIS
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State | MO
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Zip | 63105-3123
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Country | US
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Telephone | 314-265-5695
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207L00000X
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Taxonomy Name | Anesthesiology Physician
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License Number | 2021025046
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License Number State | MO
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