Healthcare Provider Details

I. General information

NPI: 1194691964
Provider Name (Legal Business Name): MADISON ELLA WERTH FNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/16/2025
Last Update Date: 01/06/2026
Certification Date: 01/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

227 SAINT PAUL ST
BALTIMORE MD
21202-2001
US

IV. Provider business mailing address

230 RODGERS FORGE RD APT C
BALTIMORE MD
21212-1333
US

V. Phone/Fax

Practice location:
  • Phone: 410-332-9330
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberR239305
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: