Healthcare Provider Details

I. General information

NPI: 1902923055
Provider Name (Legal Business Name): MARILYN CHRISTINE MADDEN ANP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/23/2007
Last Update Date: 08/24/2020
Certification Date: 08/24/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3205 RANDALL PKWY SUITE 105
WILMINGTON NC
28403-2564
US

IV. Provider business mailing address

1502 W NC HIGHWAY 54 STE 103
DURHAM NC
27707-5572
US

V. Phone/Fax

Practice location:
  • Phone: 910-742-9243
  • Fax: 888-746-1787
Mailing address:
  • Phone: 910-742-9243
  • Fax: 888-746-1787

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number900370
License Number StateNC
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPRN11002773
License Number StateFL
# 3
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number900370
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: