Healthcare Provider Details

I. General information

NPI: 1104480136
Provider Name (Legal Business Name): MADISON ECKLES NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/25/2019
Last Update Date: 12/17/2024
Certification Date: 12/17/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2535 S DOWNING ST STE 380
DENVER CO
80210-5850
US

IV. Provider business mailing address

2535 S DOWNING ST STE 380
DENVER CO
80210-5850
US

V. Phone/Fax

Practice location:
  • Phone: 303-778-5797
  • Fax: 303-778-5205
Mailing address:
  • Phone: 303-778-5797
  • Fax: 303-778-5205

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number1073868
License Number StateTX
# 2
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberRN2311744
License Number StateMA
# 3
Primary TaxonomyY
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License NumberC-APN.0102583-C-NP
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: