Provider Demographics
NPI:1023273893
Name:NADEAU, LEANNE M (PA-C)
Entity type:Individual
Prefix:
First Name:LEANNE
Middle Name:M
Last Name:NADEAU
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:P O BOX 183
Mailing Address - Street 2:8 ISLAND STREET
Mailing Address - City:MARSHFIELD
Mailing Address - State:MA
Mailing Address - Zip Code:02050
Mailing Address - Country:US
Mailing Address - Phone:781-424-0757
Mailing Address - Fax:
Practice Address - Street 1:333 BUDLONG RD
Practice Address - Street 2:
Practice Address - City:CRANSTON
Practice Address - State:RI
Practice Address - Zip Code:02920-6337
Practice Address - Country:US
Practice Address - Phone:401-943-4530
Practice Address - Fax:401-943-5107
Is Sole Proprietor?:No
Enumeration Date:2008-07-22
Last Update Date:2010-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA542363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
R02369Medicare UPIN