Healthcare Provider Details

I. General information

NPI: 1013497833
Provider Name (Legal Business Name): MADDEN WILSON RDN, LDN, CNSC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MADDEN MARIE HOGAN RDN, LDN, CNSC

II. Dates (important events)

Enumeration Date: 08/21/2018
Last Update Date: 08/21/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2100 CLINCH AVE STE 510
KNOXVILLE TN
37916-2225
US

IV. Provider business mailing address

1324 WILLMANN LN
KNOXVILLE TN
37919-8147
US

V. Phone/Fax

Practice location:
  • Phone: 865-546-3998
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number2836
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: