Healthcare Provider Details

I. General information

NPI: 1588578496
Provider Name (Legal Business Name): MADISON JONES
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/29/2026
Last Update Date: 09/29/2026
Certification Date: 09/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

19991 HALL RD STE 105
MACOMB MI
48044-4254
US

IV. Provider business mailing address

21525 ULRICH ST
CLINTON TOWNSHIP MI
48036-3717
US

V. Phone/Fax

Practice location:
  • Phone: 586-446-8688
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number4704370481
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: