Healthcare Provider Details

I. General information

NPI: 1932710217
Provider Name (Legal Business Name): MADELINE ELYSE CHELKO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/11/2020
Last Update Date: 12/04/2025
Certification Date: 12/04/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9305 W THOMAS RD
PHOENIX AZ
85037-3328
US

IV. Provider business mailing address

9305 W THOMAS RD STE 150
PHOENIX AZ
85037-3360
US

V. Phone/Fax

Practice location:
  • Phone: 480-756-6000
  • Fax: 855-636-8770
Mailing address:
  • Phone: 480-756-6000
  • Fax: 855-636-8770

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LW0102X
TaxonomyWomen's Health Nurse Practitioner
License Number304559
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: