Healthcare Provider Details

I. General information

NPI: 1033947544
Provider Name (Legal Business Name): MADELINE MURRAY TELLER BSN-RN, CDCES
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MADELINE MURRAY CARLSON

II. Dates (important events)

Enumeration Date: 07/25/2024
Last Update Date: 01/21/2025
Certification Date: 01/21/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 MEDICAL CENTER DR # 6M
LEBANON NH
03756-1000
US

IV. Provider business mailing address

42 MAY ST
ENFIELD NH
03748-3024
US

V. Phone/Fax

Practice location:
  • Phone: 603-653-9877
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number112804-21
License Number StateNH
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number041533492
License Number StateIL
# 3
Primary TaxonomyY
Taxonomy Code163WD0400X
TaxonomyDiabetes Educator Registered Nurse
License Number32300974
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: