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NPI Code Detail

MEDICARE: MISS MEGHAN MARIE MADEA CNM, NP

MEDICARE: MISS MEGHAN MARIE MADEA CNM, NP
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
1363LW0102XWomen's Health Nurse Practitioner0064MP
2367A00000XAdvanced Practice Midwife16959TN

General Provider Information

NPI Number : 1033397880
Entity Type Code : Individual
Provider Name (Legal Business Name) : MISS MEGHAN MARIE MADEA CNM, NP
Provider Business Mailing Address
First Line : 877 JEFFERSON AVE
Second Line : ATTN: PROVIDER ENROLLMENT
City : MEMPHIS
State : TN
Zip : 38103-2807
Country : US
Telephone Number : 901-545-8336
Fax Number :
Provider Business Practice Location Address
First Line : 2500 PERES AVE
Second Line :
City : MEMPHIS
State : TN
Zip : 38108-1660
Country : US
Telephone Number : 901-515-5500
Fax Number : 901-458-5591
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/04/2008
Last Update Date : 12/03/2014

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