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General NPI Number Information
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NPI Number | 1548124266
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Entity Type | Individual
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Provider Name | MADISON LANE WELLEN PA-C
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Gender | Female
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Dates
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Enumeration Date | 12/16/2025
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Last Update Date | 12/16/2025
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Provider Practice Location Address
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Address Line | 1211 E BROADWAY
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City | COLUMBIA
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State | MO
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Zip | 65201
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Country | US
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Telephone | 573-442-2211
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Fax |
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Provider Business Mailing Address
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Address Line | 3301 FAIRWAY DR
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City | HIGHLAND
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State | IL
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Zip | 62249-2804
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Country | US
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Telephone | 618-792-8102
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number |
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License Number State |
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