Basic Information
| Provider Information | |||||||||
| NPI: | 1821404278 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | NADEAU | ||||||||
| FirstName: | NELLIE | ||||||||
| MiddleName: | F | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 4951 BUSINESS PARK BLVD | ||||||||
| Address2: | |||||||||
| City: | ANCHORAGE | ||||||||
| State: | AK | ||||||||
| PostalCode: | 995037174 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9077437200 | ||||||||
| FaxNumber: | 9077437241 | ||||||||
| Practice Location | |||||||||
| Address1: | 4951 BUSINESS PARK BLVD | ||||||||
| Address2: | |||||||||
| City: | ANCHORAGE | ||||||||
| State: | AK | ||||||||
| PostalCode: | 99503 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9077437200 | ||||||||
| FaxNumber: | 9077437241 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/07/2014 | ||||||||
| LastUpdateDate: | 02/05/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 02/05/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | 8328 | AK | Y | Allopathic & Osteopathic Physicians | Family Medicine |
ID Information
| ID | Type | State | Issuer | Description | 1613901 | 05 | AK | MEDICAID |