Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 102L00000X | Psychologist | 6301007867 | MI |
N | 103T00000X | Psychologist | 6301007867 | MI |
N | 103G00000X | Clinical Psychologist | 6301007867 | MI |
N | 103TC0700X | Clinical Psychologist | 6301007867 | MI |
N | 103TC2200X | Clinical Child & Adolescent Psychologist | 6301007867 | MI |
N | 103TF0200X | Forensic Psychologist | 6301007867 | MI |
N | 103TH0100X | Health Service | 6301007867 | MI |
NPI | 1487714036 |
---|---|
Provider Name | Dr. Missi Nadeau |
First Address | Muskegon, MI 49445-5092 |
Second Address | Muskegon, MI 49441-2507 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 12/12/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0007761442 | AETNA (01) | MI |
108577 | VALUE OPTIONS (01) | MI |
297650000 | MAGELLAN (01) | MI |
680F145240 | BCBSM (01) | MI |
7000028531 | PRIORITY HEALTH (01) | MI |