Healthcare Provider Details

I. General information

NPI: 1356583793
Provider Name (Legal Business Name): LOIS-JEAN MARIE MADISON NP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/31/2009
Last Update Date: 07/24/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

76 VETERANS AVE
BATH NY
14810-0810
US

IV. Provider business mailing address

8450 TOWNLINE RD
WAYLAND NY
14572-9332
US

V. Phone/Fax

Practice location:
  • Phone: 607-664-4000
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License NumberF304991-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: