Provider Demographics
NPI:1083458152
Name:ENGLE, MADELINE MARIE (MSN, AG-ACNP)
Entity type:Individual
Prefix:
First Name:MADELINE
Middle Name:MARIE
Last Name:ENGLE
Suffix:
Gender:F
Credentials:MSN, AG-ACNP
Other - Prefix:
Other - First Name:MADELINE
Other - Middle Name:MARIE
Other - Last Name:FREIER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:30 DOUGHERTY DR
Mailing Address - Street 2:
Mailing Address - City:LEMOYNE
Mailing Address - State:PA
Mailing Address - Zip Code:17043-1173
Mailing Address - Country:US
Mailing Address - Phone:717-713-9895
Mailing Address - Fax:
Practice Address - Street 1:PO BOX 980510
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23298-0510
Practice Address - Country:US
Practice Address - Phone:804-628-4327
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-06-24
Last Update Date:2024-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0024190500363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner