Healthcare Provider Details

I. General information

NPI: 1114842234
Provider Name (Legal Business Name): CARLENDIA MADDEN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/10/2026
Last Update Date: 08/10/2026
Certification Date: 08/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4902 S CHAMPLAIN AVE
CHICAGO IL
60615-2509
US

IV. Provider business mailing address

4902 S CHAMPLAIN AVE
CHICAGO IL
60615-2509
US

V. Phone/Fax

Practice location:
  • Phone: 312-978-7549
  • Fax:
Mailing address:
  • Phone: 312-978-7549
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number041262748
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: