Healthcare Provider Details

I. General information

NPI: 1902700057
Provider Name (Legal Business Name): MADISON SHARON MALONEY
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/05/2026
Last Update Date: 10/05/2026
Certification Date: 10/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1507 E NEWBERRY ST
APPLETON WI
54915-2723
US

IV. Provider business mailing address

1507 E NEWBERRY ST
APPLETON WI
54915-2723
US

V. Phone/Fax

Practice location:
  • Phone: 920-850-0003
  • Fax:
Mailing address:
  • Phone: 920-850-0003
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number110462330
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: