MEDICARE: OLIVIA MADLOCK-STORK

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	163W00000X	Registered Nurse	4704368109	MI

General Provider Information

NPI Number	:	1962335703
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	OLIVIA MADLOCK-STORK

Provider Business Mailing Address
First Line	:	5098 VENOY RD
Second Line	:
City	:	SAGINAW
State	:	MI
Zip	:	48604-1127
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	5098 VENOY RD
Second Line	:
City	:	SAGINAW
State	:	MI
Zip	:	48604-1127
Country	:	US
Telephone Number	:	989-412-3458
Fax Number	:

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

Provider Enumeration Date	:	06/03/2026
Last Update Date	:	06/03/2026

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Directions to “ OLIVIA MADLOCK-STORK ” Practice Location

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