Healthcare Provider Details

I. General information

NPI: 1023922564
Provider Name (Legal Business Name): MADALYN JEAN BEAVER
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: MADALYN JEAN OWEN

II. Dates (important events)

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

III. Provider practice location address

621 E JOLLY RD
LANSING MI
48910-6804
US

IV. Provider business mailing address

334 N GRINNELL ST
JACKSON MI
49202-4212
US

V. Phone/Fax

Practice location:
  • Phone: 517-393-5203
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: