=====================================================
General NPI Number Information
=====================================================
NPI Number | 1629878301
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | MADISON FIELDS
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/13/2025
-----------------------------------------------------
Last Update Date | 03/13/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1145 CHARLES ST
-----------------------------------------------------
City | WELLSBURG
-----------------------------------------------------
State | WV
-----------------------------------------------------
Zip | 26070-1623
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 740-632-7557
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 42535 JEWETT SCIO RD
-----------------------------------------------------
City | JEWETT
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 43986-9773
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone |
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 374U00000X
-----------------------------------------------------
Taxonomy Name | Home Health Aide
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------