Phyllis Nadeau Landers, NP-C

Key facts

NPI

1306027255

Entity type

Individual (NPI type 1)

Primary specialty

Family Nurse Practitioner 363LF0000X

License

RN096607 (GA)

Practice address

4222 Fairbanks Dr
Oakwood, GA 30566-2811

Phone

(770) 534-6053

Fax

(770) 534-6695

NPI assigned

Nov 20, 2007

Sex

Female

Sole proprietor

No

Medicare participation

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

National Provider Directory

Medicare enrollment (NPD)

Yes

Credentials

Nurse Practitioner

Specialties & licenses

Addresses

Other identifiers

Other names

• Phyllis Anne Nadeau Former name

The complete NPPES record for this NPI in the NPI Registry API JSON format, last updated by the provider on Jul 19, 2011.

{
    "created_epoch": "1195516800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1311033600000",
    "number": "1306027255",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 658",
            "city": "GAINESVILLE",
            "state": "GA",
            "postal_code": "305030658",
            "telephone_number": "770-718-1122",
            "fax_number": "770-535-7445"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4222 FAIRBANKS DR",
            "city": "OAKWOOD",
            "state": "GA",
            "postal_code": "305662811",
            "telephone_number": "770-534-6053",
            "fax_number": "770-534-6695"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "LANDERS",
        "first_name": "PHYLLIS",
        "middle_name": "NADEAU",
        "name_prefix": "Mrs.",
        "credential": "NP-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-11-20",
        "last_updated": "2011-07-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "GA",
            "license": "RN096607",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "AMERIGROUP",
            "identifier": "01372617",
            "state": "GA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "701221561A",
            "state": "GA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "WELLCARE OF GEORGIA",
            "identifier": "563030",
            "state": "GA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "PHYLLIS",
            "last_name": "NADEAU",
            "middle_name": "ANNE",
            "credential": "NP-C",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

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