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NPI Code Detail

MEDICARE: ALLISON MADDY NP-C

MEDICARE: ALLISON MADDY NP-C
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1363LF0000XFamily Nurse Practitioner0024172716VA

General Provider Information

NPI Number : 1205219649
Entity Type Code : Individual
Provider Name (Legal Business Name) : ALLISON MADDY NP-C
Provider Business Mailing Address
First Line : 1280 MAIN ST
Second Line : SUITE A
City : ALTAVISTA
State : VA
Zip : 24517-1465
Country : US
Telephone Number : 434-309-1165
Fax Number :
Provider Business Practice Location Address
First Line : 1280 MAIN ST
Second Line : SUITE A
City : ALTAVISTA
State : VA
Zip : 24517-1465
Country : US
Telephone Number : 434-309-1165
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/02/2015
Last Update Date : 07/02/2015

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