Provider Demographics
NPI:1699172783
Name:GAUDREAU, DEANA ANNETTE (NP-C)
Entity type:Individual
Prefix:
First Name:DEANA
Middle Name:ANNETTE
Last Name:GAUDREAU
Suffix:
Gender:F
Credentials:NP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7907 POWERS BLVD
Mailing Address - Street 2:
Mailing Address - City:CHANHASSEN
Mailing Address - State:MN
Mailing Address - Zip Code:55317-9502
Mailing Address - Country:US
Mailing Address - Phone:952-906-7835
Mailing Address - Fax:952-906-7837
Practice Address - Street 1:7907 POWERS BLVD
Practice Address - Street 2:
Practice Address - City:CHANHASSEN
Practice Address - State:MN
Practice Address - Zip Code:55317-9502
Practice Address - Country:US
Practice Address - Phone:952-906-7835
Practice Address - Fax:952-906-7837
Is Sole Proprietor?:No
Enumeration Date:2014-12-04
Last Update Date:2014-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNR 189674-7363LA2200X, 363LG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology
No363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health