Healthcare Provider Details

I. General information

NPI: 1972475804
Provider Name (Legal Business Name): MADISON OBOYLE FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/19/2025
Last Update Date: 10/24/2025
Certification Date: 09/19/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4851 E PICKARD ST STE 1770
MT PLEASANT MI
48858-2029
US

IV. Provider business mailing address

2616 PINE RIVER RD
SAINT LOUIS MI
48880-9358
US

V. Phone/Fax

Practice location:
  • Phone: 989-956-9117
  • Fax:
Mailing address:
  • Phone: 989-956-9117
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number4704369262
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: