Healthcare Provider Details

I. General information

NPI: 1316526312
Provider Name (Legal Business Name): WENDY MADDEN RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/06/2021
Last Update Date: 04/06/2021
Certification Date: 04/06/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

930 20TH ST S
BIRMINGHAM AL
35205-2610
US

IV. Provider business mailing address

3410 WAVERLY DR
BIRMINGHAM AL
35209-5526
US

V. Phone/Fax

Practice location:
  • Phone: 205-996-0153
  • Fax:
Mailing address:
  • Phone: 120-561-6499
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WC1600X
TaxonomyContinuing Education/Staff Development Registered Nurse
License Number1094524
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: