Healthcare Provider Details

I. General information

NPI: 1780410357
Provider Name (Legal Business Name): MADELYN NICOLE SAGRECY
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/11/2024
Last Update Date: 09/11/2024
Certification Date: 09/11/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

555 S FLOYD ST
LOUISVILLE KY
40202-3822
US

IV. Provider business mailing address

555 S FLOYD ST
LOUISVILLE KY
40202-3822
US

V. Phone/Fax

Practice location:
  • Phone: 859-481-8025
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WP0200X
TaxonomyPediatric Registered Nurse
License Number4020956
License Number StateKY
# 2
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: