Healthcare Provider Details

I. General information

NPI: 1235987926
Provider Name (Legal Business Name): MADISON ARNOLD DOYLE APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MADISON MARIE ARNOLD

II. Dates (important events)

Enumeration Date: 05/08/2024
Last Update Date: 05/08/2024
Certification Date: 05/08/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3040 S CICERO AVE
CICERO IL
60804-3638
US

IV. Provider business mailing address

1718 W SUPERIOR ST APT 2E
CHICAGO IL
60622-8060
US

V. Phone/Fax

Practice location:
  • Phone: 708-780-9777
  • Fax:
Mailing address:
  • Phone: 772-631-8830
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License Number209029675
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number041465226
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: