Healthcare Provider Details

I. General information

NPI: 1467135293
Provider Name (Legal Business Name): PATRICK MADLEY JR. RN
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/09/2023
Last Update Date: 08/27/2024
Certification Date: 08/27/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20 YORK ST
NEW HAVEN CT
06510-3220
US

IV. Provider business mailing address

367 ORANGE ST APT 711
NEW HAVEN CT
06511-6452
US

V. Phone/Fax

Practice location:
  • Phone: 203-927-4201
  • Fax:
Mailing address:
  • Phone: 203-927-4201
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WP0200X
TaxonomyPediatric Registered Nurse
License Number167528
License Number StateCT
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPRN04112
License Number StateRI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: