MEDICARE: MADELYN WILKE CRNA

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	367500000X	Certified Registered Nurse Anesthetist	4052028	KY
2	163WC0200X	Critical Care Medicine Registered Nurse	1162538	KY

General Provider Information

NPI Number	:	1508576810
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MADELYN WILKE CRNA

Provider Business Mailing Address
First Line	:	1402 MERCANTILE DR
Second Line	:
City	:	HIGHLAND
State	:	IL
Zip	:	62249-1263
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1000 S LIMESTONE ST
Second Line	:
City	:	LEXINGTON
State	:	KY
Zip	:	40536-0001
Country	:	US
Telephone Number	:	859-257-1000
Fax Number	:

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

Provider Enumeration Date	:	11/28/2022
Last Update Date	:	02/04/2026

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