MEDICARE: MADISON MARIE DEVAULT NP

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
1	163W00000X	Registered Nurse	28229350A	IN
2	363LF0000X	Family Nurse Practitioner	71010915A	IN

General Provider Information

NPI Number	:	1235724139
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MADISON MARIE DEVAULT NP

Provider Business Mailing Address
First Line	:	13345 ILLINOIS ST
Second Line	:
City	:	CARMEL
State	:	IN
Zip	:	46032-3318
Country	:	US
Telephone Number	:	317-396-1300
Fax Number	:

Provider Business Practice Location Address
First Line	:	14540 PRAIRIE LAKES BLVD N STE 104
Second Line	:
City	:	NOBLESVILLE
State	:	IN
Zip	:	46060-5051
Country	:	US
Telephone Number	:	317-396-1300
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/03/2021
Last Update Date	:	11/22/2024

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