MEDICARE: ADRIENNE MCFADDEN

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	363LA2200X	Adult Health Nurse Practitioner	4704240965	MI

General Provider Information

NPI Number	:	1699196881
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ADRIENNE MCFADDEN

Provider Business Mailing Address
First Line	:	2261 HORSESHOE DR
Second Line	:
City	:	WEST BLOOMFIELD
State	:	MI
Zip	:	48322-2522
Country	:	US
Telephone Number	:	248-895-7350
Fax Number	:

Provider Business Practice Location Address
First Line	:	2261 HORSESHOE DR
Second Line	:
City	:	WEST BLOOMFIELD
State	:	MI
Zip	:	48322-2522
Country	:	US
Telephone Number	:	248-895-7350
Fax Number	:

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

Provider Enumeration Date	:	12/15/2013
Last Update Date	:	03/13/2017

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