Healthcare Provider Details

I. General information

NPI: 1104488329
Provider Name (Legal Business Name): MADISON ELIZABETH SPRINKLE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/09/2019
Last Update Date: 07/09/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

877 E GANNON AVE
ZEBULON NC
27597-9314
US

IV. Provider business mailing address

3428 CHEYENNE RD
RALEIGH NC
27609-7410
US

V. Phone/Fax

Practice location:
  • Phone: 919-269-7343
  • Fax:
Mailing address:
  • Phone: 919-749-9683
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberP013600
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: