Basic Information
| Provider Information | |||||||||
| NPI: | 1487049359 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | NADEAU | ||||||||
| FirstName: | STEPHANIE | ||||||||
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| Credential: | NP-C | ||||||||
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| Mailing Information | |||||||||
| Address1: | 4720 NELSON BROGDON BLVD | ||||||||
| Address2: | |||||||||
| City: | BUFORD | ||||||||
| State: | GA | ||||||||
| PostalCode: | 305183480 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7709451990 | ||||||||
| FaxNumber: | 7709453661 | ||||||||
| Practice Location | |||||||||
| Address1: | 4720 NELSON BROGDON BLVD | ||||||||
| Address2: | |||||||||
| City: | BUFORD | ||||||||
| State: | GA | ||||||||
| PostalCode: | 305183480 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7709451990 | ||||||||
| FaxNumber: | 7709453661 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/30/2015 | ||||||||
| LastUpdateDate: | 03/30/2015 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363L00000X | RN215537 | GA | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner |
ID Information
| ID | Type | State | Issuer | Description | F1214243 | 01 | GA | AMERICAN ACADEMY OF NURSE PRACTITIONERS CERTIFICATION | OTHER | RN215537 | 01 | GA | GEORGIA STATE BOARD OF NURSING LICENSURE | OTHER |