Provider Demographics
NPI:1063227262
Name:LUX, MADISON LYNNE (PA)
Entity type:Individual
Prefix:
First Name:MADISON
Middle Name:LYNNE
Last Name:LUX
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3 CAMPBELL ST APT 3F
Mailing Address - Street 2:
Mailing Address - City:LEBANON
Mailing Address - State:NH
Mailing Address - Zip Code:03766-1335
Mailing Address - Country:US
Mailing Address - Phone:207-467-5624
Mailing Address - Fax:
Practice Address - Street 1:3 CAMPBELL ST APT 3F
Practice Address - Street 2:
Practice Address - City:LEBANON
Practice Address - State:NH
Practice Address - Zip Code:03766-1335
Practice Address - Country:US
Practice Address - Phone:207-467-5624
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-02-12
Last Update Date:2025-02-12
Deactivation Date:
Deactivation Code:
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical