Provider Demographics
NPI:1609694363
Name:NAVEDO, NANETTE R (LMT, LE, MMP, MLD-C)
Entity type:Individual
Prefix:MRS
First Name:NANETTE
Middle Name:R
Last Name:NAVEDO
Suffix:
Gender:F
Credentials:LMT, LE, MMP, MLD-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:520 GA HIGHWAY 247 S STE 401
Mailing Address - Street 2:
Mailing Address - City:BONAIRE
Mailing Address - State:GA
Mailing Address - Zip Code:31005-3890
Mailing Address - Country:US
Mailing Address - Phone:478-216-8012
Mailing Address - Fax:
Practice Address - Street 1:520 GA HIGHWAY 247 S STE 401
Practice Address - Street 2:
Practice Address - City:BONAIRE
Practice Address - State:GA
Practice Address - Zip Code:31005-3890
Practice Address - Country:US
Practice Address - Phone:478-216-8012
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-10-01
Last Update Date:2024-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAMT011012225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist