Healthcare Provider Details

I. General information

NPI: 1952793408
Provider Name (Legal Business Name): NICHELLE MADDEN D.O.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: NICHELLE ARNOLD

II. Dates (important events)

Enumeration Date: 02/20/2015
Last Update Date: 10/01/2020
Certification Date: 10/01/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5056 N CENTRAL AVE
PHOENIX AZ
85012-1521
US

IV. Provider business mailing address

5056 N CENTRAL AVE
PHOENIX AZ
85012-1521
US

V. Phone/Fax

Practice location:
  • Phone: 602-222-9111
  • Fax: 602-222-9333
Mailing address:
  • Phone: 602-222-9111
  • Fax: 602-222-9333

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License NumberOS1482
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License Number008662
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: