Healthcare Provider Details

I. General information

NPI: 1447191457
Provider Name (Legal Business Name): GEORGETTA L MADDOX BSN/RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/03/2026
Last Update Date: 04/03/2026
Certification Date: 04/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

814 N 26TH ST
MILWAUKEE WI
53233-1508
US

IV. Provider business mailing address

814 N 26TH ST
MILWAUKEE WI
53233-1508
US

V. Phone/Fax

Practice location:
  • Phone: 414-207-4560
  • Fax: 414-448-6946
Mailing address:
  • Phone: 414-207-4560
  • Fax: 414-448-6946

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number1265
License Number StateWI
# 2
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number264448-30
License Number StateWI
# 3
Primary TaxonomyN
Taxonomy Code163WA2000X
TaxonomyAdministrator Registered Nurse
License Number1265
License Number StateWI
# 4
Primary TaxonomyN
Taxonomy Code163WC1600X
TaxonomyContinuing Education/Staff Development Registered Nurse
License Number264448-30
License Number StateWI
# 5
Primary TaxonomyN
Taxonomy Code163WH0200X
TaxonomyHome Health Registered Nurse
License Number264448-30
License Number StateWI
# 6
Primary TaxonomyN
Taxonomy Code163WP0000X
TaxonomyPain Management Registered Nurse
License Number264448-30
License Number StateWI
# 7
Primary TaxonomyN
Taxonomy Code163WP0808X
TaxonomyPsychiatric/Mental Health Registered Nurse
License Number264448-30
License Number StateWI
# 8
Primary TaxonomyN
Taxonomy Code163WP2201X
TaxonomyAmbulatory Care Registered Nurse
License Number264448-30
License Number StateWI
# 9
Primary TaxonomyN
Taxonomy Code163WR0400X
TaxonomyRehabilitation Registered Nurse
License Number264448-30
License Number StateWI
# 10
Primary TaxonomyN
Taxonomy Code163WW0000X
TaxonomyWound Care Registered Nurse
License Number264448-30
License Number StateWI
# 11
Primary TaxonomyN
Taxonomy Code163WX0106X
TaxonomyOccupational Health Registered Nurse
License Number264448-30
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: