Healthcare Provider Details

I. General information

NPI: 1124302039
Provider Name (Legal Business Name): CARMEN P MADDOCKS NP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/11/2011
Last Update Date: 11/06/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1400 N GILBERT RD STE 1
GILBERT AZ
85234-2328
US

IV. Provider business mailing address

7558 W THUNDERBIRD RD STE 1-496
PEORIA AZ
85381-6080
US

V. Phone/Fax

Practice location:
  • Phone: 623-977-2707
  • Fax:
Mailing address:
  • Phone: 623-977-2707
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAP4234
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: