Healthcare Provider Details

I. General information

NPI: 1316984065
Provider Name (Legal Business Name): JEANETTE MARIE MADDIX APRN BC CS
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 06/01/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

323 BOSTON POST RD
SUDBURY MA
01776-3022
US

IV. Provider business mailing address

43 SAXONY DR
SUDBURY MA
01776
US

V. Phone/Fax

Practice location:
  • Phone: 508-243-6076
  • Fax: 978-443-3717
Mailing address:
  • Phone: 978-443-6083
  • Fax: 978-443-3717

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code364S00000X
TaxonomyClinical Nurse Specialist
License Number146433
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: