Healthcare Provider Details

I. General information

NPI: 1174406656
Provider Name (Legal Business Name): MADISON HONEA RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MADISON DANIELS RN

II. Dates (important events)

Enumeration Date: 07/30/2025
Last Update Date: 07/30/2025
Certification Date: 07/30/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 CIVIC PLZ NW STE SB606
ALBUQUERQUE NM
87102-2109
US

IV. Provider business mailing address

4849 GIBSON BLVD SE APT 25
ALBUQUERQUE NM
87108-4553
US

V. Phone/Fax

Practice location:
  • Phone: 505-602-9355
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number79630
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: