Healthcare Provider Details

I. General information

NPI: 1144006560
Provider Name (Legal Business Name): MADELYN E BONEY NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/01/2023
Last Update Date: 12/05/2023
Certification Date: 12/05/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2219 GARFIELD ST
TWO RIVERS WI
54241-2416
US

IV. Provider business mailing address

PO BOX 735044
CHICAGO IL
60673-5044
US

V. Phone/Fax

Practice location:
  • Phone: 920-793-2281
  • Fax: 920-793-2281
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number14467-033
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: