Healthcare Provider Details

I. General information

NPI: 1629981766
Provider Name (Legal Business Name): CHARISSE L MADISON
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/28/2026
Last Update Date: 09/28/2026
Certification Date: 09/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5151 MONROE ST STE 250F
TOLEDO OH
43623-3469
US

IV. Provider business mailing address

5151 MONROE ST STE 250F
TOLEDO OH
43623-3469
US

V. Phone/Fax

Practice location:
  • Phone: 419-508-6748
  • Fax:
Mailing address:
  • Phone: 419-508-6748
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberAPRN.CNP.0043242
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: