MEDICARE: NADINE LEE VERDURA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	222Q00000X	Developmental Therapist		FL
2	104100000X	Social Worker

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1699811976
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	NADINE LEE VERDURA

Provider Business Mailing Address
First Line	:	8961 DANIELS CENTER DR
Second Line	:	SUITE 401
City	:	FORT MYERS
State	:	FL
Zip	:	33912-0314
Country	:	US
Telephone Number	:	239-433-6700
Fax Number	:

Provider Business Practice Location Address
First Line	:	8961 DANIELS CENTER DR
Second Line	:	SUITE 401
City	:	FORT MYERS
State	:	FL
Zip	:	33912-0314
Country	:	US
Telephone Number	:	239-433-6700
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/30/2007
Last Update Date	:	11/02/2012

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Directions to “ NADINE LEE VERDURA ” Practice Location

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