MEDICARE: MS. MADISON NICOLE SCHALLER LBA

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	103K00000X	Behavior Analyst	872	NC
2	171M00000X	Case Manager/Care Coordinator

General Provider Information

NPI Number	:	1215598206
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. MADISON NICOLE SCHALLER LBA

Provider Business Mailing Address
First Line	:	PO BOX 11077
Second Line	:
City	:	GOLDSBORO
State	:	NC
Zip	:	27532-5018
Country	:	US
Telephone Number	:	919-947-4015
Fax Number	:	855-492-1625

Provider Business Practice Location Address
First Line	:	1031 WH SMITH BLVD
Second Line	:
City	:	GREENVILLE
State	:	NC
Zip	:	27834
Country	:	US
Telephone Number	:	252-493-6252
Fax Number	:	855-492-1625

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

Provider Enumeration Date	:	06/21/2019
Last Update Date	:	01/24/2024

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