MEDICARE: MRS. REBECCA ANN MADDEN RN,BSN

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	163WH0200X	Home Health Registered Nurse	RN3175972	FL

General Provider Information

NPI Number	:	1013281591
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. REBECCA ANN MADDEN RN,BSN

Provider Business Mailing Address
First Line	:	5708 BAY FOREST DR
Second Line	:
City	:	PENSACOLA
State	:	FL
Zip	:	32526-2441
Country	:	US
Telephone Number	:	850-455-4854
Fax Number	:

Provider Business Practice Location Address
First Line	:	5708 BAY FOREST DR
Second Line	:
City	:	PENSACOLA
State	:	FL
Zip	:	32526-2441
Country	:	US
Telephone Number	:	850-455-4854
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/01/2012
Last Update Date	:	03/01/2012

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