Healthcare Provider Details

I. General information

NPI: 1588400725
Provider Name (Legal Business Name): MADISON FUSS CRNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/08/2024
Last Update Date: 07/08/2024
Certification Date: 07/08/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3500 CIVIC CENTER BLVD
PHILADELPHIA PA
19104-4395
US

IV. Provider business mailing address

1002 S 19TH ST UNIT B
PHILADELPHIA PA
19146-2607
US

V. Phone/Fax

Practice location:
  • Phone: 215-590-2730
  • Fax:
Mailing address:
  • Phone: 610-573-0301
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License NumberSP029048
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: