Deana Annette Gaudreau, NP-C

Primary specialty

Gerontology Nurse PractitionerTaxonomy code 363LG0600X

License

R 189674-7 Issued in MN

Practice address

7907 Powers Blvd
Chanhassen, MN 55317-9502

Phone

(952) 906-7835

Fax

(952) 906-7837

NPI assigned

Dec 4, 2014

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Certified Nurse Practitioner, Nurse Practitioner

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1417651200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1417651200000",
    "number": "1699172783",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "7907 POWERS BLVD",
            "city": "CHANHASSEN",
            "state": "MN",
            "postal_code": "553179502",
            "telephone_number": "952-906-7835",
            "fax_number": "952-906-7837"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "7907 POWERS BLVD",
            "city": "CHANHASSEN",
            "state": "MN",
            "postal_code": "553179502",
            "telephone_number": "952-906-7835",
            "fax_number": "952-906-7837"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GAUDREAU",
        "first_name": "DEANA",
        "middle_name": "ANNETTE",
        "credential": "NP-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2014-12-04",
        "last_updated": "2014-12-04",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LA2200X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Adult Health",
            "state": "MN",
            "license": "R 189674-7",
            "primary": false
        },
        {
            "code": "363LG0600X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Gerontology",
            "state": "MN",
            "license": "R 189674-7",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Gerontology Nurse Practitioner in Chanhassen, MN
• Providers in Chanhassen, MN by specialty
• Gerontology Nurse Practitioner in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 4, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.