Healthcare Provider Details

I. General information

NPI: 1124242581
Provider Name (Legal Business Name): NINA MADDEN BS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/13/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1510 W FRANKLIN ST SUITE A
EVANSVILLE IN
47710-1032
US

IV. Provider business mailing address

626 PARKVIEW DR
BOONVILLE IN
47601-2244
US

V. Phone/Fax

Practice location:
  • Phone: 812-424-0223
  • Fax: 812-424-0226
Mailing address:
  • Phone: 812-483-7371
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: