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NPI Code Detail

MEDICARE: MRS. VANESSA MARIE MADDEN-GILYARD FNP-BC

MEDICARE:  MRS. VANESSA MARIE MADDEN-GILYARD  FNP-BC
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
1363LF0000XFamily Nurse Practitioner5022971NC

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1667652-1OTHERNYLICENSE NUMBER

General Provider Information

NPI Number : 1639500481
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. VANESSA MARIE MADDEN-GILYARD FNP-BC
Provider Business Mailing Address
First Line : 10421 KEMPSFORD DR
Second Line :
City : CHARLOTTE
State : NC
Zip : 28262-2718
Country : US
Telephone Number : 980-433-0517
Fax Number :
Provider Business Practice Location Address
First Line : 113 BALLAD AVE
Second Line :
City : ROCHESTER
State : NY
Zip : 14626-1224
Country : US
Telephone Number : 585-267-0588
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 12/04/2013
Last Update Date : 02/04/2026

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