Healthcare Provider Details

I. General information

NPI: 1609900836
Provider Name (Legal Business Name): MADONNA L FERRIS APRN-BC-FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/16/2007
Last Update Date: 04/24/2020
Certification Date: 04/24/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

601 BUSINESS LOOP 70 W STE 275
COLUMBIA MO
65203-2585
US

IV. Provider business mailing address

3711 N EVERBROOK LN
MUNCIE IN
47304-5270
US

V. Phone/Fax

Practice location:
  • Phone: 573-874-0008
  • Fax: 573-875-5350
Mailing address:
  • Phone: 765-287-8593
  • Fax: 765-287-8593

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number71009895A
License Number StateIN
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number129711
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: