MEDICARE: MRS. VALERIE MADDOX

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	363LF0000X	Family Nurse Practitioner	0029031	OH

General Provider Information

NPI Number	:	1437728938
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. VALERIE MADDOX

Provider Business Mailing Address
First Line	:	4555 SELHURST RD APT SUITE
Second Line	:
City	:	NORTH OLMSTED
State	:	OH
Zip	:	44070-2616
Country	:	US
Telephone Number	:	216-645-7814
Fax Number	:

Provider Business Practice Location Address
First Line	:	9500 EUCLID AVE
Second Line	:
City	:	CLEVELAND
State	:	OH
Zip	:	44195-2616
Country	:	US
Telephone Number	:	216-444-4412
Fax Number	:

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

Provider Enumeration Date	:	06/21/2021
Last Update Date	:	08/25/2021

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Directions to “ MRS. VALERIE MADDOX ” Practice Location

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