Healthcare Provider Details

I. General information

NPI: 1730058058
Provider Name (Legal Business Name): MADISON WOLDT RN, BSN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/04/2025
Last Update Date: 11/04/2025
Certification Date: 11/04/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

310 W JACKSON AVE APT 108
KNOXVILLE TN
37902-1368
US

IV. Provider business mailing address

310 W JACKSON AVE APT 108
KNOXVILLE TN
37902-1368
US

V. Phone/Fax

Practice location:
  • Phone: 920-410-9880
  • Fax:
Mailing address:
  • Phone: 920-410-9880
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WC0200X
TaxonomyCritical Care Medicine Registered Nurse
License Number278547
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: