Healthcare Provider Details

I. General information

NPI: 1609710524
Provider Name (Legal Business Name): MADISON B WRIGHT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/20/2026
Last Update Date: 04/20/2026
Certification Date: 04/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

117 N UNION ST
PONCA NE
68770-7297
US

IV. Provider business mailing address

PO BOX 645
PONCA NE
68770-0645
US

V. Phone/Fax

Practice location:
  • Phone: 712-251-7523
  • Fax: 402-755-2387
Mailing address:
  • Phone: 712-251-7523
  • Fax: 402-755-2387

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code372500000X
TaxonomyChore Provider
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: